上下唇血液供应及其临床意义

目的：研究上下唇的血液供应,为新的组织瓣设计提供解剖学基础。方法：对10具从面动脉灌注红色乳胶的成年新鲜尸体标本的口周区域进行解剖研究,在2具尸体标本的面静脉内注入兰色乳胶。在3.5倍的手术放大镜下解剖显著血管。结果：上唇动脉发生浅隔支与深隔支,向上走行进入鼻中隔前下部参与克氏动脉丛的组成。观察到2种新的下唇动脉的分布情况。下唇动脉沿途发出唇颏支,与进入颏部的其它血管分支相互吻合。结论：上下唇血供丰富,可设计含浅、深隔支的上唇岛状组织瓣、含鼻隔支的岛状鼻中隔软骨粘膜瓣及含颏唇支的颏唇瓣;了解下唇动脉的解剖变异,对成功地施行一期下唇动脉岛状瓣手术是很重要的。     

面动脉穿支蒂颊黏膜瓣重建泪道的解剖学基础

目的为面动脉穿支蒂颊黏膜瓣重建泪道提供解剖基础。方法在10个20侧动脉内灌注红色乳胶的成人头标本上解剖观测:①面动脉穿支的起源、分支与分布;②颊动脉的起源、分支与分布;③面动脉与颊动脉的吻合。另在1侧新鲜标本上进行摹拟手术设计。结果颊黏膜的血供为多源性,主要由面动脉、颊动脉和上牙槽后动脉发出的穿支供养。①面动脉自颈外动脉发出,行至咬肌前缘越过下颌骨底达面部后,再斜向内上至内眦处与鼻背动脉吻合,沿途除发出分支营养颈、面部相应区域外,在口角外侧(1.10±0.31)cm处分出1~3支颊支,支配颊肌与颊黏膜前中部,并与颊动脉颊支、上牙槽后动脉颊支形成吻合;②颊动脉发自上颌动脉的翼肌段,行于颞肌下部深面前下方向,沿途发支分布于颊黏膜后中部,并与面动脉穿支相互吻合。当上颌动脉分出颊支细短时,则由粗大的上牙槽后动脉颊支(占5%)代偿。结论颊黏膜瓣血供丰富,可形成以面动脉穿支为蒂颊黏膜瓣转位重建泪道。     

外鼻的动脉供应

在25具成年尸体50侧标本上解剖了外鼻的动脉。分布到外鼻的动脉有上唇动脉的鼻中隔动脉、面动脉的鼻翼下缘动脉、鼻翼动脉和鼻外侧动脉;还有眼动脉的鼻背动脉;有的眶下动脉也发出分支到外鼻。对上述动脉的起源、行程、分布、吻合和外径等进行了观察和测量。对与人中部组织瓣、鼻翼下缘组织瓣和鼻背岛状瓣有关的动脉应用解剖进行了讨论。对鼻外侧动脉和鼻背动脉的命名问题提出了商榷。     

单侧完全性唇腭裂胎儿颌面部血供的应用解剖

目的为单侧完全性唇腭裂胎儿宫内手术修复提供解剖学基础。方法制作和观察21～32周正常和单侧完全性唇腭裂胎儿头颈部血管铸型标本,比较它们颌面部血供的来源及吻合情况。结果①正常胎儿颌面部血供主要来源于面动脉、颏下动脉、下唇动脉、上唇动脉、鼻翼下缘动脉、鼻翼动脉、鼻外侧动脉、鼻背动脉、眶下动脉及面横动脉等,这些动脉及其分支构筑颌面部组织丰富的血管网;②单侧完全性唇腭裂胎儿患侧上唇动脉沿裂缘向上至鼻翼基底部与鼻翼下缘动脉等相吻合,患侧部分腭骨缺损暴露的腭大动脉穿过骨残端与患侧鼻腔内的血管相吻合。结论对单侧完全性唇腭裂胎儿颌面部进行宫内修复手术,重点在鼻部和上唇部的血供,主要以上唇动脉、鼻翼下缘动脉和腭大动脉为主。     

下唇血管的解剖学研究及其临床意义

用动脉造影、铸型和组织切片方法,观察了17具尸体下唇部的血管.下唇动脉和副下唇动脉出现率分别为55.6％和32.5％.下唇动脉和/或副下唇动脉的终末支组成下唇缘恒定存在的下唇动脉弓,有5种组成类型.面动脉在下唇还发不知名的细小分支,对代偿缺如的下唇动脉起一定作用.文中对下唇瓣的临床应用问题作了讨论.     

口唇段面动脉与面静脉的临床应用解剖研究

目的对口唇段面动脉、面静脉及其分属支作解剖观测,为临床应用充实形态学数据。方法解剖经福尔马林固定的教学用成人尸体标本32例64侧,观测口唇段面动脉、面静脉及其分属支的起始、走行、分布、管径及相互位置关系等情况,对结果作相关分析。结果面动脉与面静脉在下颌骨下缘处位置关系不恒定。以下颌骨下缘与面动脉交界处为起点,左右两侧面动脉距口角、下颌角、颏隆凸中点等处的距离,左侧分别为(5.49±0.63)cm、(2.50±0.89)cm、(6.20±1.68)cm,右侧分别为(5.69±0.72)cm、(2.56±1.08)cm、(6.85±1.86)cm;在下颌骨下缘处面动脉管径左侧为(0.33±0.08)cm、右侧为(0.38±0.07)cm,面静脉管径左侧为(0.40±0.12)cm、右侧为(0.42±0.18)cm。口唇段面动脉与面静脉属支不一定同行,且左右基本不对称。上唇动脉位置较为恒定,下唇动脉存在较大变异。结论口唇段面动脉与面静脉走行、位置关系及其分(属)支变异较大;上唇动脉较下唇动脉更易于定位。熟悉血管分布情况对面部皮瓣移植及口唇部手术具有极大意义。     

臀下动脉吻合支的解剖学观测及其临床应用

目的为以臀下动脉吻合支臀中肌止腱支为蒂的大转子后外侧骨、骨膜瓣移位术提供解剖学依据.方法在30侧动脉灌注红色乳胶液的成人下肢尸体标本上,重点观测臀下动脉吻合支臀中肌止腱支的走行、分布与吻合.结果臀下动脉吻合支沿梨状肌下缘行向大转子途中,在距动脉起点4.4±1.2cm处分出臀中肌止腱支,分布于臀中肌止腱及大转子尖端并参与大转子后外侧动脉网.结论可设计以臀中肌止腱支为蒂蹬大转子后外侧骨、骨膜瓣移位修复股骨头缺血性坏死.     

口周岛状皮瓣动脉构筑的显微解剖学研究

目的　为口周岛状皮瓣切取提供更精准的解剖学资料。 方法　采用63例（126侧）头颈部铸型标本,观察口周动脉的来源、走行、分支分布、变异和动脉构筑特点。 结果　口周的血供主要来自上唇动脉、下唇动脉、唇颏动脉和颏下动脉升支。上唇动脉多于口角平面以上（68.25%）或以下（22.22%）起自面动脉,形成面动脉的1条分支（44.44%）或终支（49.21%）,左、右侧呈对称（51.59%）或不对称（46.83%）分布;偶见缺如（1.59%）。下唇动脉多于下颌骨下缘上方（43.65%）或口角平面下方（28.89%）起自面动脉,形成面动脉的1条分支（61.90%）或终支（25.40%）,呈对称（44.44%）或不对称（47.62%）分布;缺如者占（7.94%）。两侧上、下唇动脉相互吻合,围绕口裂形成动脉环,营养口裂、鼻区及颏区。唇颏动脉于下颌下缘附近起自面动脉,多为1支（约55%）或缺如（约30%）,也可见2支（约10%）或3支（约5%）。颏下动脉在颏下中部发出2 ~ 12支升支,与下唇动脉降支和唇颏动脉形成唇颏血管丛,营养颏部皮肤。 结论　口周区域血供来源较多、吻合丰富,在口周形成动脉环及动脉网。但口周动脉的起始、走形和分布变异较大,动脉构筑形式不定,在切取口周岛状皮瓣时,术前超声探查十分必要。     

以串连血管为蒂的股骨外侧髁骨(膜)瓣的应用解剖

目的：为治疗股骨干骨不连、骨缺损提供一种新的骨（膜）瓣供区。方法：在５０侧成人下肢标本上,解剖观察了膝上外侧动脉的起始、走行、分支分布及其与旋股外侧动脉降支的吻合类型。结果：膝上外侧动脉于股骨外侧髁上方（２．５ ± ０．５）ｃｍ处起自于腘动脉外侧壁,分出升支、横支和降支。升支和／或横支与旋股外侧动脉降支有 ３种类型的吻合,吻合率为 ９２％（４６侧）,吻合处外径为（１．３ ± ０．３）ｍｍ。结论：以旋股外侧动脉降支与膝上外侧动脉升支和／或横支串连为蒂可截取股骨外侧髁骨（膜）瓣用于修复股骨干骨不连及骨缺损。     

口周岛状皮瓣动脉构筑的显微解剖学研究

目的为口周岛状皮瓣切取提供更精准的解剖学资料。方法采用63例(126侧)头颈部铸型标本,观察口周动脉的来源、走行、分支分布、变异和动脉构筑特点。结果口周的血供主要来自上唇动脉、下唇动脉、唇颏动脉和颏下动脉升支。上唇动脉多于口角平面以上(68.25%)或以下(22.22%)起自面动脉,形成面动脉的1条分支(44.44%)或终支(49.21%),左、右侧呈对称(51.59%)或不对称(46.83%)分布;偶见缺如(1.59%)。下唇动脉多于下颌骨下缘上方(43.65%)或口角平面下方(28.89%)起自面动脉,形成面动脉的1条分支(61.90%)或终支(25.40%),呈对称(44.44%)或不对称(47.62%)分布;缺如者占(7.94%)。两侧上、下唇动脉相互吻合,围绕口裂形成动脉环,营养口裂、鼻区及颏区。唇颏动脉于下颌下缘附近起自面动脉,多为1支(约55%)或缺如(约30%),也可见2支(约10%)或3支(约5%)。颏下动脉在颏下中部发出2～12支升支,与下唇动脉降支和唇颏动脉形成唇颏血管丛,营养颏部皮肤。结论口周区域血供来源较多、吻合丰富,在口周形成动脉环及动脉网。但口周动脉的起始、走形和分布变异较大,动脉构筑形式不定,在切取口周岛状皮瓣时,术前超声探查十分必要。     

Anatomic study of the blood supply of perioral region

The use of flaps to reconstruct lip defects requires detailed knowledge of the local vasculature. New flaps for surgery around the mouth can be devised if the surgeon knows the distribution of the perioral arterial branches. Examination of the anatomy of perioral branches of the facial artery (FA) confirmed the consistent presence of septal and alar branches in the upper lip and a labiomental branch in the lower lip. Mucosal flaps from the upper lip based on the deep septal branch or the alar branch of the FA can be used to restore lower lip defects. A composite flap from the lower lip supplied by the labiomental branch of the FA can be used to restore combined defects of the upper lip and nose or partial defects of the lower lip. We studied the vascular anatomy of the perioral region in 25 cadaver dissections. Fixation was by 10% formaldehyde solution. Red latex was injected into the common carotid arteries before dissection. In the 50 specimens, the primary supplying vessels were identified and the size and distribution of the vessels were investigated. The FA was symmetrical in 17 (68%) of 25 heads. It terminated as an angular facial vessel in 11 (22%), as a nasal facial vessel in 30 (60%), as an alar vessel in six (12%), and as a superior labial vessel in two (4%) facial halves. It terminated as a hypoplastic type of FA in one (2%) facial half. The average external diameter of the superior labial artery (SLA) was 1.6 mm (min-max: 0.6-2.8 mm) at its origin. The origin of the SLA was superior to the angle of the mouth in 34 of 47 specimens (72.3%), and at the angle of the mouth in 13 of 47 specimens (27.7%). In two of the remaining three specimens, the SLA was the continuation of the FA and the other was of the hypoplastic type. The SLA supplied the columellar branches in all specimens except for the hypoplastic type (49 specimens). Columellar branches were classified according to their number and their type. In five specimens (10%) the inferior labial artery (ILA) was not found. In the other specimens, the site of origin of the ILA varied between the lower margin of the mandible and the corner of the mouth. Its external diameter measured min-max: 0.5-1.5 mm. The ILA arose from the FA above the angle of mouth in 4 specimens (8%), inferior to the angle of mouth in 11 specimens (22%), and at angle of mouth in 30 specimens (60%). We observed that the labiomental arteries, which formed anastomoses between the FA, ILA, and submental artery, showed variations in their course in the labiomental region. We suggest that knowledge of the location of arteries with respect to easily identifiable landmarks will help to avoid complications at surgery.     

Reconstruction of total lower lip, labial commissure and palatomaxillary defect with composite island cheek flap

Functional and cosmetic restoration of total lower lip, labial commissure, and palatomaxillary defects can be achieved by using multiform flaps. The possibility of reconstruction of these areas with composite island cheek flap is presented. The flap was used in three patients who were surgically treated between 1993 and 1998. In one female patient, total lower lip and chin defect was restored with a small contralateral platysma muscle cutaneous flap. The functional and cosmetic result was achieved with composite island cheek flap. In the other two cases, reconstruction was performed without another flap. Composite island cheek flap is supplied with bloody by the facial artery and vein, and contains mucous membrane, muscle and skin of the cheek. In two cases, the flap was formed by the anterior part of the buccal muscle, and in the case with the reconstruction of labial commissure, the greater and lesser zygomatic muscles with levator muscle of the angle of mouth were used. By freeing the blood vessels from the surrounding structures, isolation and transsection of minor vessel branches allowed straightening of the tortuous main vessels. With this technique, excellent functional and satisfactory cosmetic results were achieved in a single act, with minimal morbidity for labial commissure, and total lower lip or palatomaxillary defect reconstruction.     

多血管神经蒂腹内斜肌瓣修复面瘫的解剖学基础

目的：为多血管神经蒂腹内斜肌瓣修复晚期面瘫提供解剖学基础。方法：在３６侧成尸标本上,对腹内斜肌的形态、血供及神经支配进行解剖观测。结果：腹内斜肌中部上１／２肌腹主要由第１１肋间神经支配,下１／２肌腹主要由肋下神经支配。上１／２肌腹的血供６６．７％来自第１１肋间后动脉,３３．３％来自旋髂深动脉的髂嵴支;下１／２肌腹的血供主要来自旋髂深动脉的腹壁肌支。第１１肋间神经、肋下神经在腋后线横径分别为２．２ｍｍ和２．４ｍｍ,入肌点距腋后线长分别为１３．３ｃｍ和１３．８ｃｍ。第１１肋间后动脉在腋后线外径为１．７ｍｍ,入肌点距腋后线长为１３．１ｃｍ;旋髂深动脉腹壁肌支和髂嵴支的起始外径分别为１．３ｍｍ和１．８ｍｍ,入肌点至起点长分别为５．１ｃｍ和８．６ｃｍ。结论：吻合多血管神经腹内斜肌瓣移植可全面修复晚期面瘫     

面神经下颌缘支的应用解剖

目的了解面神经下颌缘支的正常层次解剖位置,为涉及面侧区和颌下区的美容外科手术提供临床应用解剖学资料。方法解剖33具（共66例）成人尸体标本的头颈部标本,观察了面神经下颌缘支的分支类型、走行、与面动脉的位置关系以及穿出腮腺处和与面动脉的交叉处的体表位置。结果面神经下颌缘支为1-2支,以单干型居多,约占58%,大多行于下颌骨下缘上方约占44%,行于骨下缘下方者占5%。未发现面神经下颌缘支不与面动脉交叉,位置在均下颌角下缘上、下方约0.5-1 cm范围内。面神经下颌缘支经过面动脉的浅面和深面者分别占89%和6%;面神经下颌缘支穿出腮腺处的体表位置分别在下颌角上方和下颌支后缘前方1 cm交点附近,面神经下颌缘支与面动脉交处距下颌支后缘约4 cm,距下颌骨下缘约1 cm。结论面神经下颌缘支的毗邻和行程关系较为复杂,了解其与周围结构的重要位置关系,可以减少美容外科手术因神经损伤造成下唇及口角功能障碍的发生。     

肩胛下血管蒂复合组织瓣移植的解剖学基础

目的：为以肩胛下血管为蒂复合组织瓣移植提供解剖学基础。方法：４０侧成人上肢标本解剖观察肩胛下动脉的分支类型及分布。结果：肩胛下动脉分支有３种类型：①肩胛下动脉直接分出旋肩胛动脉和胸背动脉,占５２．５％;②肩胛下动脉发出旋肩胛、胸背、旋肱后或胸外动脉,占４０％;③旋肩胛动脉与胸背动脉分别起于腋动脉,占７．５％。旋肩胛动脉恒定发浅、深支,浅支分布于肩胛冈下部筋膜皮肤,深支分布于肩胛骨外侧缘。胸背动脉恒定发肩胛骨支、前锯肌支,分布于肩胛骨外侧缘中下部、前锯肌及第５～７肋。胸背动脉于肩胛骨下角上方１．９ｃｍ处分为内、外侧支。结论：９２．５％可以肩胛下血管为蒂形成：①肩胛（骨）皮瓣与背阔肌皮瓣;②肩胛（骨）皮瓣与侧胸皮瓣;③肩胛（骨）皮瓣与前锯肌肋骨瓣。７．５％则可以胸背动脉为蒂形成背阔肌皮瓣与前锯肌肋骨瓣。     

A detailed observation of variations of the facial artery, with emphasis on the superior labial artery

The reconstruction of lip defects through the use of the Abbė flap and other lip flap procedures involves surgical manipulation of one of the major branches of the facial artery, specifically the superior labial artery (SLA). We examined 284 hemifaces derived from 142 formalin fixed cadavers. Observations regarding the distribution patterns of the facial artery were recognized and categorized into five Types, labeled “A” through “E”.Type A (135, 47.5%): facial artery bifurcates into SLA and lateral nasal (the latter gives off inferior and superior alar and ends as angular); Type B (110, 38.7%): similar to Type A, except lateral nasal terminates as superior alar (angular artery is absent); Type C (24, 8.4%): facial artery terminates as SLA; Type D (11, 3.8%): angular artery arises directly from facial arterial trunk rather than as the termination of lateral nasal, with the facial artery ending as superior alar; Type E (4, 1.4%): facial artery terminates as a rudimentary twig without providing any significant branches. Furthermore, we were able to categorize variations within each Type. Sub-Type variations were examined in Types A through C (A: 1–7; B: 1–4; C: 1–3). Our aim was to equip both the anatomist and surgeon with a more thorough understanding of the vasculature of the face, as well as to enable plastic surgeons to have a more confident approach to reconstructive procedures in this region.     

阴部外动脉的应用解剖学

本观察了30例（60侧）成人尸体的阴部外动脉的起始，行程，外径，长度及分支分布，并对其皮瓣设计进行了讨论。     

以髂腰血管为蒂髂骨（膜）瓣移植的应用解剖

目的：为髂腰血管蒂髂骨（膜）瓣移植提供解剖学基础。方法：在２７具灌注红色乳胶的成尸标本上，对髂腰血管的起始、走行及分支分布进行解剖观测，并在标本上摹拟骨瓣切取。结果：髂腰动脉９６．３％起自髂内动脉，３．７％起自髂总动脉。其主干７９．６％走行髂肌浅面，２０．４％走行于髂肌深面，末端均分布髂嵴中部，并与前、后血管之间形成吻合。髂腰动脉起始处外径为２．７ｍｍ，腰大肌外侧缘处外径为１．６ｍｍ。由腰大肌外侧缘至其末端的长度为４．５ｃｍ，分布于髂嵴中部的范围长为７．０ｃｍ左右。结论：以髂腰血管为蒂可切取髂嵴中部骨瓣移植     

比目鱼肌带腓骨肌骨瓣的应用解剖

在３０例成人下肢标本上对比目鱼肌附着于腓骨、胫骨的部位、与腓肠肌合并部位进行了观察。对比目鱼肌的血管供应、神经支配进行了测量分析和研究。比目鱼肌的供血动脉来自胫后动脉和腓动脉，肌瓣最大支动脉起始部外径男２．１０ｍｍ；女１．６２ｍｍ，肌瓣最大支动脉蒂长男２．５２ｃｍ；女１．９３ｃｍ。同时为选用比目鱼肌带腓骨复合瓣提供了形态学资料。