背阔肌肌皮瓣的血管解剖及其临床应用

目的 探讨背阔肌肌皮瓣与血供的关系，为肌皮瓣的再划分、转位及移植提供解剖学基础。方法 用大体解剖学、血管X 线造影方法，对48例尸体背阔肌进行观察，并回顾背阔肌肌皮瓣进行临床应用31例的效果。结果 背阔肌肌皮瓣有多个血供来源，其中胸背动脉主干分布于背阔肌外上部。恒定地分出内侧支和外侧支，具有各自分布区域。背阔肌内下部由肋间动脉和腰动脉供应。据X 线造影所见，它们与胸背动脉分支间吻合明显，口径在320～550 μm之间。背阔肌表面皮肤血供均来自深方肌皮穿支，越向内下方，穿支间吻合稀疏，口径亦细小。临床应用肌皮瓣做肿物切除后创面修复，乳房再造，修复小腿缺损等共31例，术后肌皮瓣30例完全成活，1例肌皮瓣远端早期出现部分血运障碍征象，经对症处理后，血运逐步改善，伤口延期愈合。 结论 背阔肌肌皮瓣，按其动脉分支及其吻合特点可分为3个部分，为整体或部分分离、转位或移植，保持肌功能提供血管解剖基础。

Vascular anatomy and clinical application of latissimus dorsi myocutaneous flap

Objective To explore the relationship between latissimus dorsi myocutaneous flap and blood supply, so as to provide a scientific basis for the re-division, transposition and transplantation of latissimus dorsi myocutaneous flap.Methods The latissimus dorsi muscle of 48 cadavers were observed by anatomy and angiography. The clinical applications of latissimus dorsi myocutaneous flap in 31 cases were reviewed.Results The latissimus dorsi myocutaneous flap had many sources of blood supply. The main thoracodorsal artery was distributed in the upper and outer latissimus dorsi muscle. The medial and lateral branches were separated steadily with their respective distribution areas. The inner and lower parts of latissimus dorsi muscle were supplied by intercostal and lumbar arteries. The anastomosis between them and the branches of thoracodorsal artery was obvious according to X-ray angiography. The caliber was between 320-550 μm. The blood supply of the skin superficial to the latissimus dorsi muscle was from the myocutaneous artery. But the anastomosis between the perforating branches was sparse and the caliber was small near the inner and lower parts. Myocutaneous flaps were applied for wound repair, breast reconstruction and leg defect repair after mass excision in 31 cases. Thirty cases of myocutaneous flaps survived completely post-operation. One case of myocutaneous flap had early signs of partial blood flow disturbance. After treatment, blood flow gradually improved and wound healing delayed.Conclusion The latissimus dorsi myocutaneous flap can be divided into 3 parts according to their arterial branches and anastomotic characteristics, which can provide the vascular anatomical basis for whole or partial separation, transposition or transplantation and preservation of muscle function.