CAT、DSA、x-ray与解剖技术相结合确立小腿后外侧皮支链皮瓣血管构筑

The cutaneous branch-chain flap refers to the branch of the adjacent perforator using the same axis from the cutaneous branch-chain between vascular for cut flap blood. The cutaneous branch-chain flap is more formed that the aim of treatment for microsurgery techniques, which include without sacrificing the main area for blood vessels, cut is not deep fascia, the donor site damage is small, highly survival rate. In previously ,we have studied the cutaneous branch-chain flap of the posterolateral lower leg which use the microscope, confirmed that exists in superficial fascia. But it has not been obtained intuitive image data about the subdermal vascular net. And it has not been confirmed whether the vascular chain of the superficial fascia come along with the same direction; The communicating branch between Subdermal vascular chain and in the superficial fascia vascular chain, whether a direct continuation of the perforator or not, and How to connect,what are the main form of expression in the cutaneous branch-chain flap of the posterolateral lower leg, In the posterolateral lower leg whether supply the common area of the skin blood exists or not; How to design and accurately cut in the cutaneous branch-chain flap of the posterolateral lower leg; In view of the above, we decided to use three-dimensional imaging and CTA reconstruction and the microsopic anatomical method ,to build further research in the cutaneous branch-chain flap of the posterolateral lower leg

皮支链皮瓣，是指应用同一轴心血管发出的相邻穿支间分支形成的皮支链为血供所切取的皮瓣。皮支链皮瓣的提出，更加符合不牺牲供区的主要血管、不切开深筋膜、供区损伤小、成活率高等显微外科技术的治疗初衷。在前期研究中我们利用镜下解剖对小腿后外侧皮支链皮瓣进行了研究，证实浅筋膜内存在着皮支血管链。但对于真皮下血管网的走行排列没有得到直观的图像资料，与浅筋膜内血管链是否有着同样的走行方向也没有得到证实。真皮下血管链与浅筋膜内血管链之间的交通支是否为穿支的直接延续，又是如何连接的；小腿后外侧皮支链血管构筑主要有哪些表现形式；小腿后外侧皮肤是否存在着穿支共同区这一皮肤血供情况；如何能够设计并准确切取小腿后外侧皮支链皮瓣；鉴于上述情况我们决定应用CTA重建小腿后外侧血管及皮瓣各层血管链的三维影像与镜下解剖相结合方法，对小腿后外侧皮支链皮瓣的血管构筑做进一步的研究。

本研项目重点研究了小腿皮支链皮瓣的血管构筑，在项目执行期间通过运用CT扫描、Micro-CT扫描、DR摄影及手术显微镜镜下解剖等研究方法，目前取得如下研究成果：①对穿支血管进行了分级和命名；②从形态学上证实了真皮下血管网的存在及血管来源；③初步明确小腿部皮支链皮瓣的血管构筑；④初步对小腿部大型皮支链皮瓣的切取提出了建议；⑤明确了皮支链皮瓣的轴向性；⑥明确了小腿部皮神经，浅静脉营养血管的形成。