Hui K C, Zhang F, Lineaweaver W C, Moon W, Buncke G M, Buncke H J
Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, CA 94305, USA.
Ann Plast Surg. 1999 Feb;42(2):132-6.
Because of its relative ease of dissection, increased length of the vascular pedicle, and excellent diameter for anastomosis, the serratus anterior-rib composite flap has been used to reconstruct bony and soft-tissue defects in the face and lower extremities. However, no data are available on optimal rib level or harvest location. The authors report the results of the vascular anatomy of this flap in 6 fresh cadavers and 2 clinical patients using this flap to reconstruct a defect in the hand. Arteriograms were performed through the thoracodorsal artery, and microscopic dissections were done at the rib periosteum. The sixth through the ninth ribs showed consistent filling of their respective intercostal vessels. The rib segments near the anterior axillary line had the most abundant communicating vessels between the serratus and the periosteum. In two patients, the serratus-rib composite free flap provided excellent bone and muscle length for reconstructing the first metacarpal defect.
由于前锯肌-肋骨复合组织瓣相对易于解剖、血管蒂长度增加且吻合直径极佳，已被用于修复面部和下肢的骨与软组织缺损。然而，关于最佳肋骨水平或取材位置尚无数据。作者报告了在6具新鲜尸体和2例临床患者中对该组织瓣进行血管解剖的结果，这2例患者使用该组织瓣修复手部缺损。通过胸背动脉进行动脉造影，并在肋骨骨膜处进行显微解剖。第六至第九肋骨显示其各自的肋间血管持续充盈。靠近腋前线的肋骨段在前锯肌和骨膜之间有最丰富的交通血管。在两名患者中，前锯肌-肋骨复合游离组织瓣为重建第一掌骨缺损提供了极佳的骨和肌肉长度。
