Kompatscher Peter, Manestar Mirjana, Schuster Antonius, Lang Axel, Beer Gertrude M
Division of Plastic, Aesthetic, and Reconstructive Surgery and the Institute of Radiology, Landesklinikum Feldkirch, Feldkirch, Austria.
Plast Reconstr Surg. 2005 Jan;115(1):77-83.
The purpose of this study was to investigate the presence and the precise course of the pectoral branch of the thoracoacromial vessels on the underside of the pectoralis major muscle by anatomical dissection and by color Doppler ultrasound. A further goal was to determine whether these vessels were suitable as recipient vessels in microsurgery and supermicrosurgery for breast reconstruction. In 18 cadavers, the pectoral branch of the thoracoacromial vessels was followed caudally until the diameter of the artery diminished to 1 mm. The same examination was carried out in 40 young female volunteers by tracing the vessel course with color Doppler ultrasound. The 1-mm cutoff point of the artery was measured with reference to the manubrium, the midsternal line, the clavicle, and the upper border of the closest rib. In addition, in the cadavers, the 2-mm cutoff point was determined. At both cutoff points, the diameter of the accompanying vein was measured. The pectoral branch of the thoracoacromial vessels with the artery and concomitant veins could be detected on all 100 undersides of the pectoralis major muscle, anatomically and sonographically. In their course from the acromial region downward, the arteries reached a diameter of 1 mm at an average of 9.9 cm from the manubrium, horizontally 9.4 cm from the midsternal line, and vertically 4.0 cm from the lower border of the clavicle. The 1-mm reference point was situated on the upper border of the third rib in 85 percent of cases. The average distance between the 1-mm and the 2-mm cutoff points was 3.5 cm. At the 1-mm cutoff point, the diameter of the vein was 0.9 mm, and at the 2-mm cutoff point, it was 1.7 mm. Because of their central position at the anterior hemithorax, these vessels are easily accessible from mastectomy incisions, even in skin-sparing mastectomies; the donor-site morbidity is negligible; and as the diameters of the vessels gradually decrease along their caudal course, the recipient site can be chosen precisely according to the length and the diameter of the donor vessels and major mismatch can be avoided. Thus, the pectoral branches of the thoracoacromial vessels are well suited as recipient vessels for (super)microsurgery and are a very promising addendum to the thoracodorsal and internal mammary vessels.
本研究的目的是通过解剖 dissection 和彩色多普勒超声，调查胸肩峰血管胸肌支在胸大肌下表面的存在情况及其确切走行。另一个目标是确定这些血管是否适合作为乳房重建显微外科和超显微外科中的受区血管。在18具尸体中，追踪胸肩峰血管胸肌支直至动脉直径减小至1毫米。在40名年轻女性志愿者中，通过彩色多普勒超声追踪血管走行进行了同样的检查。以胸骨柄、胸骨中线、锁骨和最靠近肋骨的上缘为参照，测量动脉的1毫米截断点。此外，在尸体中确定2毫米截断点。在这两个截断点处，测量伴行静脉的直径。在所有100个胸大肌下表面，通过解剖和超声检查均能检测到带有动脉和伴行静脉的胸肩峰血管胸肌支。在其从肩峰区域向下走行过程中，动脉在距胸骨柄平均9.9厘米、距胸骨中线水平9.4厘米、距锁骨下缘垂直4.0厘米处达到1毫米直径。85%的病例中，1毫米参考点位于第三肋骨上缘。1毫米和2毫米截断点之间的平均距离为3.5厘米。在1毫米截断点处，静脉直径为0.9毫米，在2毫米截断点处为1.7毫米。由于这些血管在前半胸的中心位置，即使在保留皮肤的乳房切除术中，也可从乳房切除切口轻松获取；供区并发症可忽略不计；并且由于血管直径沿其尾侧走行逐渐减小，可根据供体血管的长度和直径精确选择受区，避免严重不匹配。因此，胸肩峰血管胸肌支非常适合作为（超）显微外科的受区血管，是胸背血管和胸廓内血管非常有前景的补充。
