目的:探讨以旋髂深动脉及其分支为供应血管的旋髂深动脉皮瓣(Rubens'皮瓣)解剖学基础,为乳房再造尤其是组织缺损大的胸壁修复提供更多组织利用空间.方法:对4例8侧新鲜尸体标本进行大体解剖,以游标卡尺测量旋髂深动脉自髂外动脉发出起点位置 、起点管径 、分支数量 、起点至第一分支距离 、最粗穿支管径 、主干血管长度等,并对1例2侧新鲜标本进行手术模拟.结果:在本次进行解剖学研究的4例8侧标本中,旋髂深动脉发自股动脉走行至髂外动脉处,起点外径平均为(3.97±0.86)mm,分支数量平均为(9.16±6.22)支,起点至第一分支距离平均为(15.87±9.24)mm,平均穿支数目为(3.12±1.34)支,最粗穿支管径平均为(1.48±1.02)mm,且与腹壁下动脉之间有丰富的血管网吻合,主干血管长度平均为(132.51±48.24)mm.在进行手术模拟的1例2侧新鲜标本中,以旋髂深动脉为蒂的Rubens'皮瓣包含层次依次为皮肤 、皮下组织 、部分腹外斜肌 、部分腹内斜肌 、部分腹横肌肌袖,皮瓣体表范围长轴平均为(13.21±2.33)cm,短轴平均为(6.42±2.12)cm.对其中1例模拟成功的皮瓣用排水法测得的皮瓣体积为146.8 mL.结论:以旋髂深动脉及其分支为供应血管的Rubens'皮瓣,紧邻腹部皮瓣,利用人体髂腰部组织量较大的特点,切取皮瓣后对供区损伤较小,既有明显的瘦腰效果,又是延伸腹部皮瓣进行乳房再造及胸壁缺损修复的较好手段,有较好的临床应用前景.

Objective To provide anatomic basis for the clinical application of the transverse upper gracilis flap supplied by profunda femoris artery in breast reconstruction.Method In 8 adult cadaver lower extremities injected with red latex,we observed the presence rate,route,outer diameter and pedicle length of the branch of the profunda femoris artery.The accompanying vein and nerve were also examined.Result The presence rate of artery supplied TUG flap was 100%,in which 75%were from profunda femoris artery,and 25%from medial femoral circumflex artery.The pedicle entered the gracilis(13.21 ± 1.03) cm below the start of gracilis with outer diameter being(1.35 ±0.30) mm,giving off 2-3 cutaneous branches alongside.The pedicle length was(74.14 ±9.42) mm with outer diameter being(2.77 ±0.54) mm,and(2.83 ±0.63) mm for the accompanying vein.In our study,the presence rate of the great saphenous vein branches was87.5%,only one specimen had no branch,all the others had one with the outer diameter of(2.60 ±0.64) mm.The diameter of obturator nerve was(1.85 ± 0.53) mm.Conclusion ①The profunda femoris artery branch had a high presence rate in upper 1/3 of gracilis,thus the transverse upper gracilis flap is a reliable donor site for breast reconstruction.②There were relatively constant great saphenous vein branch,which could be reserved for better venous return.③It was possible to make a perforator flap in some cases to avoid unnecessary muscle damage.④The feasibility of the transverse upper gracilis flap supplied by branch of the profunda femoris artery was demonstrated by the modeling operation on the cadaver.⑤The incision was subterranean and more acceptable by patients.⑥The flap was designed on the basis of the defect size during mastectomy,for readily closing without tension,and it can be used not only on the whole breast reconstruction,but also on the local damage after breast-conserving surgery,furthermore,it can provide two flaps to repair bilateral breast coloboma.

Objective To present a method for breast reconstruction with the superficial inferior epigastric artery (S1EA) flap and to summarize the operative experiences. Methods The diameter and distribution were evaluated with multipledetector-row computed tomography (MDCT) angiography and doppler perfusion flowmeter. Bipedicle superficial inferior epigastric artery flap was designed below umbilicus. Superficial inferior epigastric artery and vein were anastomosed to the internal mammary artery and vein. Results Since 2007, we have used the superficial inferior epigastric artery flap in 4 cases of breast reconstruction. Four flaps survived completely. With the follow-up of 6-12 months, the reconstructed breasts were well-shaped and there were no complications such as abdominal hernia, bulge and weakness in donor sites. Conclusions Breast reconstruction using the superficial inferior epigastric artery flaps can not only preserve the advantages of the traditional method using the deep inferior epigastric perforator flaps, but also retain the maximal function of the fascia and the rectus abdominal muscle and prevent the occurrence of abdominal weakness and hernia. It is an ideal alternative method of breast reconstruction on condition that definitive preoperative assessment of vessels and skilled surgical technique are provided.

Objective To conduct a morphologic and anatomic study on nasal cartilages (including nasal alar cartilage, nasal septal cartilage and upper lateral cartilage) in Chinese, and to compare measured parameters with the other races. Methods 20 adult embalmed cadavers were dissected, 40 nasal alar cartilages, 20 nasal septal cartilages and 40 upper lateral cartilages were collected and scanned by CT, and three-dimensional images were reconstructed. As Zelnik' and Ofodile's work, the data of the images were collected. Results The distances from the nostril rim to the caudal boarder of the lateral crus in the series were (4. 54 ±0. 59) mm anteriorly, (5. 54±0. 69) mm in the middle, and (10. 45± 1. 15) mm posteriorly. The length of the lateral crus was (18. 51 ±1. 63) mm, the width was (7. 99±1. 66) mm, and the thickness was (0. 49±1. 28) mm. Conclusion The Caucasian nasal cartilages are the biggest in all races, and the other's were approximately same.

Objective To determine whether some donor areas in ear cartilage can be transplanted for reconstruction of the alar cartilage with all its elements (medial crus, junction of the medial and lateral crura, and lateral crus), with the same dimension and en bloc. Methods 40 alar cartilages and 40 ear cartilages of 20 cadavers were dissected, scanned by CT, and three-dimensional images were reconstructed. Several measurements were taken in the alar cartilage three-dimensional images, such as distance, thickness, and angle. Then they were compared with the measurements performed in the 3 donor areas in ear cartilage three-dimensional images. Results Most measurements in 3 donor areas in the ear cartilages are bigger than the homolateral alar cartilages. Conclusion This study shows that from the cavum conchae, isthmus, and tragus (CVIT region), the triangular fossa, junction of triangular fossa and helix, and helix(TFH region), the cymba concha, junction of cymba concha and helix, and helix(CBH region) en bloc resection is possible with characteristics of form and dimension similar to those of the homolateral alar cartilage.

OBJECTIVE:To find anatomic basis for clinically modifying technique of harvesting superior and inferior gluteal artery perforator flap, in order to avoid muscle lossing in conventional superior and inferior myocutaneous flaps, keep the advantage such as large rich supplied volume soft tissue.METHODS:5 cases 10 sides adult cadaver were used to study the numbers, position, Course of superior and inferior gluteal artery perforators. The position of perforators was located by ultrasound Doppler in 6 cases and 12 sides in patient's superior and inferior gluteal area.RESULTS:Superior and inferior gluteal artery originated from internal iliac artery. Several main perforators of large caliber were found in the paraischia and central portions of the gluteal muscle, its number was 10 - 15. The length of the vessels varies from 3 to 8 cm and their diameter from 1 - 1.5 mm. These significant perforators pass through the muscle itself and the fascial portion of the muscle to the overlying skin on the gluteal region. The dorsal branches of nervorum lumbalium perforate the deep fascia just above the iliac crest, lateral to the posterior superior iliac spine. If a nerve branch with a substantial diameter crosses the incision line, the nerve can be harvested within the flap. This nerve can be anastomosed to the anterior ramus of the lateral branch of the 4th intercostals nerve. In adult female, 3 - 5 perforators were located by ultrasound Doppler. They distributed in the triangle area among posterior superior iliac crest, the great trochanter and the coccyx.CONCLUSIONS:The area and diameter of perforators of superior gluteal artery were relatively confirmed. It's possible to harvest the perforator flap without any muscle. It has the advantage of conventional myocutaneous flap with out of its disadvantages. It's easy to detect those perforator by ultrasound Doppler clinically. The nerve can be harvested and anastomosed simultaneously. Because the inferior gluteal area is a weight loading area, we suggested to use superior gluteal artery perforator flap. This flap can be transferred pedicled to treat sacral pressure sores or to be transferred freely for the breast reconstruction.

OBJECTIVE:To investigate the anatomic characteristics of the perforator neurovascular bundles in the anterior abdominal wall for the anatomical basis of the sensate deep inferior epigastric perforator (DIEP) flap.METHODS:Abdominal wall dissection was performed on 9 embalmed female cadavers (18 sides).RESULTS:Most of the deep inferior epigastric perforators emerged at the anterior sheath of the rectus. There were averaged 17.5 perforators on each side, with the diameter equal to or larger than 0.5 mm in 7.8 perforators. The number of skin perforators was the greatest in the supero-medial area. 56.2 percent of vascular perforators traveled with the sensory branches while 80.9 percent of larger perforators (> or = 0.5 mm in diameter) run with the sensory branches.CONCLUSIONS:The lateral perforator neurovascular bundle was the first choice in the design of the sensate DIEP flap.

Objective To supply anatomic foundation for TRAM and DIEP flaps breast reconstruction with both sensory innervation and rectus abdominis muscle function preserved. Methods Dissections of T8～T12 nerves in anterior abdominal wall were performed on 9 embalmed female cadavers (18 sides). By reconstructing DIEP flaps in 15 cases, the natures of the intercostal nerves and the relations with deep inferior epigastric perforators were investigated. Results Most intercostal nerves pierced the rectus abdominis muscle in the lateral one third. There were interconnections between muscular branches of segmental nerves. Sensory branches traveling with vascular perforators were divided into medial branch and lateral branch. The mean length of pure sensory nerve was (27.6±12.2)mm. Conclusion It is possible to preserve sensory innervation by coapting lower intercostal nerves to the 4th thoracic nerve in TRAM and DIEP breast reconstruction. Sparing lateral one third of rectus abdominis muscle does not cause denervated atrophy in the rectus abdominis muscle after TRAM breast reconstruction.

Objective: To observe the blood vessel distribution of the cutaneous nerve and its adjacent flap in anterior and lateral thigh and to illustrate the anatomical basis of the survive of the neurocutaneous vascular flap. Methods: Twenty sides of cadaveric lower extremities were perfused with latex-lead oxide. The origins; courses, branches, distributions of the nutrient vessels of the anterior and lateral thigh cutaneous nerve (ATCN) and the relationship between these vessels and adjacent flap were studied. The clinical feasibility of the ATCN flap was discussed. Results: The anatomical courses of the ATCN were stable. There were two vascular network systems around the cutaneous nerves. There was well-developed anastomosis vascular network between the blood vessels of the cutaneous nerve and its adjacent flap. This was the survival basis of the ATCN flap. Conclusions: The anterior and lateral thigh neurocutaneous vascular flap could be designed to island flap in different patterns and used to repair soft-tissue and organ defects of perineum.

1.目的:阐明颊肌的血液供应,设计新型的岛状颊肌粘膜瓣,扩大岛状颊肌粘膜瓣的应用范围,探索瓣内肌肉的神经再支配,以进行有关器官的功能性再造的研究.

1992年我们发表了<乳房深部动脉供应及乳房内部血管构筑的巨微解剖>一文[1],在此研究基础上,设计并在临床开展了乳腺蒂乳房缩小整形术[2].此后,刘道功[3]、李森恺[4]等采用乳晕环状切口进行乳房缩小术,证实了我们提出的"乳房深部血供完全可以保证乳头、乳晕成活"这一观点.

Objective: To provide anatomical data for rationally and effectively using the pectoralis major at the plastic surgery. Methods: The blood vessels and nerves on pectoralis major muscles were measured and studied in 12 adult cadaveric specimens. Results: It was found that the abdominal portion of the pectoralis major was relatively independent and its average length was 22. 7 cm, middle width 6. 0 cm, middle thickness 3. 3 mm, length of ligament 3. 2 cm; the outer diameter of its artery was 1. 98 mm and the length form the artery's origin to its entrance to the muscular was 4. 9 cm; the diameter of its nerves was 1. 71 mm and the distance from the nerve's origin to its entrance to muscular was 5. 5 cm. Conclusions: The abdominal portion of the pectoralis major can be used in plastic surgery as a single unit.

目的研究犬气管经液氮深低温冷冻削减抗原后,用于同种异体移植(不用免疫抑制剂)的可行性. 方法实验犬17只,通过纤维支气管镜检查、粘膜血流量的测定、病理学检查、血管造影以及存活率和通畅度的计算,分别研究以单侧胸头肌瓣和双侧胸骨舌骨肌-胸骨甲状肌联合瓣包裹自体移植气管、未冷冻以及冷冻6周的同种异体移植气管术后的存活情况. 结果冷冻6周的同种异体气管移植后与自体移植的气管无明显差别,未见有单核细胞浸润,可长期存活,病理评分分别为2.22±0.37和1.33±0.28.未冷冻的同种异体气管移植后第1周时,粘膜外观以及粘膜血流量与冷冻6周的同种异体移植气管相同,但在第2周时粘膜呈现灰黑色,粘膜血流量低于第1周时的测定值.于术后2～4周移植气管坏死.显微镜下见移植气管内有大量单核细胞浸润,病理评分为19.00±0.72. 结论气管经深低温冷冻后可以削减其抗原性,同种异体移植后不发生免疫排斥反应,移植气管能够长期存活.

二甲基亚砜或合用二甲基亚砜和蔗糖是目前常用的冷冻保护剂,也是最常用于气管冻储的冷冻保护剂[1].海藻糖是近年来发现并开始应用的一种非穿透性冷冻保护剂.我们将二甲基亚砜和海藻糖合用作为气管的冷冻保护剂,探讨其是否优于其他冷冻保护剂.

OBJECTIVETo evaluate the anatomical division within latissimus dorsi and its electromyographic change as shoulder articulation movement.METHODSUsing anatomical observation, projection of trophic vessel and nerve of latissimus dorsi was marked in the surface of skin. Electromyographic assessment of different area of latissimus dorsi was measured.RESULTSThe latissimus dorsi was mainly supplied by thoracodorsal and its interior and external branches. The latissimus dorsi can be divided three area based on these anatomical result. Electromyographic amplitude in the three areas of muscle are different.CONCLUSIONLastissimus dorsi can be divided into three areas by thoracodorsal vessel and nerve. The third area fibres were utilized preferentially when subjects performed six kinds of movements of the shoulder joint.

OBJECTIVE:To investigate the way of revascularization of donator's trachea wrapped in united muscle flap.METHODS:Using fiberoptic bronchoscopy, histopathology and microangiography, we evaluated the tracheal mucosal blood flow, the survival rate, the percentage of patency, and the graft viability of autograft tracheas with varying lengths wrapped in one-sided sternocephalic muscle flap and two-sided sternohyoid-sternothyroid muscle flap and autograft tracheas with the length of 5 rings without wrapped in muscle flap in 32 dogs.RESULTS:In the tracheal autograft wrapped in the united muscle flap group with a length less than 4 centimeters, the submucosal blood flow of graft could be detected by laser blood flowmetry one week after transplantation, and it reached 60% of the normal, which had no significant difference between the place near the site of anastomosis and the middle part of the graft. Dense vessels could be found to grow from the wrapped muscles into the autografted trachea by microangiography. Histopathological examination demonstrated that the structure of the autograft was the same as what it originally was. the inner surface of the autograft was covered with pseudostratified columnar ciliary epithelia, and no necrotic tracheal cartilages were found. Every autograft could survive over long time. However, at 1 week, most mucous membrane in the middle part of the graft with length over 4 cm was in gray or in pale; hyperemia, edema, and haemorrhage were found near the site of anastomosis. Mucosal blood flow measured by laser blood flowmetry in the middle part of the graft was significantly less than that near the site of anastomosis. Malacia, dissolution or granulation hyperplasia occurred in midportion of the major grafts shortly after transplanatation. As for those autografted trachea without wrapping in muscles flap, mucous membranes turned black one week after the transplantation and all dogs died of graft necrosis later.CONCLUSION:One-sided sternocephalic muscle flap and two-sided sternohyoid-sternothyroid muscle flap can provide blood for the graft and the grafted trachea can survive for a long time.

Objective： To provide anatomical basis for the design of new buccinator myomucosal island flap.Methods： 10 fresh adult cadavers were injected with red latex solution in bilateral common carotid artery,and 2 of them were injected with blue latex solution in bilateral facial vein.The buccinator muscle and its vasculars and nerve were revealed and observed.Results： Originating from the facial artery,posterior buccal branch,inferior buccal branch and anterior buccal branch enter into the buccinator muscle.There are anastomosis between the posterior buccal branch and buccal artery.Originating from the lateral aspect of buccinator muscle,several veins converge into the buccal venous plexus,and drain into the facial vein or into the internal maxillary vein.Conclusion： The facial artery is the main blood supply to the buccinator muscle.Pedicled with any artery in this region,the buccinator muscosal island flap would always be viable.2 patterns of buccinator musculomucosal island flaps were designed in this study.

Objective: To provide anatomical basis for repairing the conjunctival defects of eyelied or tarsus with the nasal septal chondromucosal island flap.Methods: 10 fresh adult cadavers were injected with red latex solution in the common carotid artery,and 2 of them were injected with blue latex solution in the facial vein.Dissected under 3.5×loupe magnification,the vascular of the perinasal region and nasal septum were revealed and observed.Results： Anastomosesing with the vasculars of anterior and posterior septum,the nasal alar basal artery and nerve enter into the anterior inferior septum.Conclusion： The nasal septal chondromucosal island flap pedicled with the nasal alar basal artery and nerve can be used to repair the conjunctival defects of eyelid or tarsus.

Objective: To study the blood suply of the lip region and develop new regional flap.Methods: Red latex was injected into the facial arteries at the lower jaw border on 10 fresh cadavers.On two of these cadavers, blue latex was injected additionally into the facial vein.The vascular anatomy of the lips was revealed by dissecting the vessels between the nasal alar base and a lower mental border (magnification ×3.5).Results: A septal branch and a nasal alar basal branch from the superior liabial arteries were confirmed.A vertical labiomental branch from the inferior liabial arteries was confirmed too.Two new patterns of vascular anatomy of the inferior lip were observed.Conclusions: There is adequate blood supply on the lip region.The mucosal arterial flap and cutaneous arterial flap of the upper lip and vertical labiomental arterial flap can be designed.And to know the anatomic variation of the inferior liabial arteries is very important for performing the one-stage lower lip island arterial flap operation.