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目的对上侧胸部皮肤的血供分布规律进行解剖学研究,为上侧胸部皮瓣的设计提供解剖学依据。方法新鲜成人标本10具,灌注红色乳胶氧化铅混合物后行螺旋CT进行扫描,后数据输入Mimics 13软件进行三维重建;然后进行解剖,观察并记录第9肋以上腋中线周围管径大于0.5 mm的穿支的管径、穿出点、走形于筋膜的长度及与周围血管的吻合关系;将其中2具标本躯干的被覆组织剥离下来,行X线摄影。结果第3、第4肋间后动脉在侧胸壁的外侧支支常常缺失或管径细小。该区域的皮肤血供分布来源于旋肩胛动脉、胸外侧动脉及胸背动脉近端的穿支。10具标本共中解剖到了109支位于第5至第8肋间隙的肋间后动脉肌皮穿支;90%侧标本上有一支优势穿支的存在,外径为(0.9±0.3)mm。在25%的标本中,可以发现优势穿支与肩胛下动脉前锯肌支的分支有吻合。结论①上侧胸部可以切取以胸背动脉外侧支为蒂大型跨区皮瓣;②第5至第8肋间隙存在恒定的肋间后动脉外侧穿支,可以切取以肋间后动脉外侧穿支皮瓣来修复四肢及躯干部皮肤缺损。
Objective To anatomize the distribution of blood supply to the upper thoracic skin and provide anatomical basis for the design of the upper thoracic flap. Methods Ten fresh adult samples were infused with red latex lead oxide mixture and scanned with spiral CT. The data were then input into the Mimics 13 software for three-dimensional reconstruction. The anatomy was then performed to observe and record the diameter of the ninth axilla above the axillary line more than 0.5 mm in diameter Through the diameter of the branch, piercing point, take shape in the length of the fascia and the anastomosis of the surrounding blood vessels; of which 2 specimens of the tissue of the trunk stripped off, X-ray photography. Results The third and fourth intercostal arteries were often missing or had small diameter on the lateral branches of the lateral thoracic wall. The skin blood supply in this region is derived from the spinous branches of the spinosynovial artery, the lateral thoracic artery, and the thoracodorsal artery. A total of 109 specimens were dissected to dissect the myocutaneous perforating branch of the intercostal artery at the intercostal space between the 5th and 8th. A dominant perforator was found on 90% of the specimens with an outer diameter of (0.9 ± 0.3) mm. In 25% of the specimens, the dominant perforator was found to coincide with the branch of the saphenous artery of the subscapular artery. Conclusion ① The upper thoracic can be cut off the lateral branches of the thoracodorsal artery pedicled large trans-regional flap; ② 5 to 8 intercostal space there is a constant lateral posterolateral intercostal artery perforating branches, you can cut off the lateral intercostal artery perforating branch Flap to repair limbs and trunk skin defects.