Detailed Vascular Anatomy and Flap Harvest Technique of the Serratus Anterior/Rib Composite Flap
Detailed Vascular Anatomy and Flap Harvest Technique of the Serratus Anterior/Rib Composite Flap
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前锯肌/肋骨复合皮瓣的详细血管解剖学和皮瓣采集技术
DOI：
10.1097/prs.0000000000005087
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发表时间：
2019
影响因子：
3.6
通讯作者：
Kimata Y
中科院分区：
文献类型：
--
作者：
Matsumoto H;Shinaoka A;Ohtsuka A;Kimata Y
背景：在前锯肌/肋骨复合瓣中，从前锯肌到肋骨的血流动力学尚未得到详细分析。作者重点关注新的血液循环，其中滑动动脉从前锯肌分支分支，离开胸背动脉和肋间动脉，直接通过互连血管（轴向路径）。作者详细分析了前锯肌/肋骨复合皮瓣的血流动力学，并开发了一种新的方法皮瓣elevation.Methods：轴向路线进行了确定和分析，通过进行宏观解剖福尔马林灌注固定尸体，涉及三维CT血管造影和血管腐蚀铸造。皮瓣提升进行了新的血液循环，其中包括轴向路线，并使用吲哚菁绿色荧光angiography.Results的血流进行了评价：互连血管穿透的前锯肌附着点的前缘肋骨的平均距离为4.5 cm，并在平均距离为7.4 cm，从肋软骨交界处的肋间肌。相互连接的血管的平均直径为0.5 mm。血管腐蚀铸造有助于识别从肋间动脉分布到肋骨骨膜的多个毛细血管。此外，术中吲哚菁绿色荧光血管造影证实，从滑动脉的肋间artery.Conclusion：良好的血流在收获的移植组织可以实现包括轴向路线与骨膜血液循环在肋骨附着点的前锯肌前锯肌/肋骨复合皮瓣。
Background:The hemodynamics of blood flowing from the anterior serratus to the ribs has yet to be analyzed in detail in serratus anterior/rib composite flaps. The authors focused on new blood circulation, whereby the slip arteries branched from the serratus anterior branch, off the thoracodorsal artery and the intercostal arteries, directly through the interconnecting vessels (axial route). The authors analyzed in detail the hemodynamics of serratus anterior/rib composite flaps and developed a new method for flap elevation.Methods:The axial route was identified and analyzed by performing macroscopic autopsies of formalin perfusion-fixed cadavers involving three-dimensional computed tomographic angiography and vascular corrosion casting. Flap elevation was performed with new blood circulation, which included the axial route, and blood flow was evaluated using indocyanine green fluorescence angiography.Results:The interconnecting vessels penetrated the intercostal muscles at a mean distance of 4.5 cm from the anterior margin of the attachment sites of the serratus anterior muscle to the ribs and at a mean distance of 7.4 cm from the costochondral junction. The interconnecting vessels had a mean diameter of 0.5 mm. Vascular corrosion casting helped identify multiple capillaries that were distributed from the intercostal arteries to the periosteum of the ribs. In addition, intraoperative indocyanine green fluorescence angiography confirmed blood flow from the slip arteries to the intercostal arteries.Conclusion:Good blood flow in harvested graft tissue can be achieved by including the axial route with the periosteal blood circulation at the rib attachment sites of the serratus anterior in a serratus anterior/rib composite flap.
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