Marín-Guzke M, Sánchez-Olaso A, Fernández-Camacho F J
Plastic Surgery Unit, Universitary Hospital Ramón y Cajal, Madrid, Spain.
Surg Radiol Anat. 2005 Nov;27(4):340-6. doi: 10.1007/s00276-005-0333-8. Epub 2005 Nov 9.
In the present study we analyzed the anatomical basis for the use of the pectoralis major muscle based on alternative pedicles in order to evaluate its clinical applications in cases of potential lesion of the internal thoracic artery. The patterns of blood supply depending on the internal thoracic artery, previously dissected for coronary by-pass surgery, were studied in both sides of five embalmed cadavers and five anterior thoracic walls taken from autopsies. The secondary vascular pedicles depending on the internal thoracic artery for the pectoralis major muscle were dissected and injected with physiological saline stained solution in the embalmed cadavers. Moreover, studies of intravascular injection by means of radio-opaque contrast and physiological saline stained solution were carried out in the anterior thoracic walls obtained from clinical autopsies. The results showed that complete injection of the pectoralis major muscle was achieved depending exclusively on the two proximal perforating branches of the two first intercostal spaces, which represented the vascular pedicle for medial transposition of the pectoralis major flap, in cases with previous dissection of the internal thoracic artery for coronary by-pass.
在本研究中，我们分析了基于替代蒂使用胸大肌的解剖学基础，以评估其在胸廓内动脉潜在病变病例中的临床应用。在五具防腐尸体以及取自尸检的五个前胸壁的两侧，研究了先前为冠状动脉搭桥手术而解剖的依赖胸廓内动脉的血液供应模式。在防腐尸体中，解剖了依赖胸廓内动脉供应胸大肌的二级血管蒂，并注入生理盐水染色溶液。此外，在取自临床尸检的前胸壁中，通过不透射线造影剂和生理盐水染色溶液进行了血管内注射研究。结果表明，在先前为冠状动脉搭桥而解剖胸廓内动脉的病例中，仅依赖第一肋间间隙的两个近端穿支，即可实现胸大肌的完全注射，这两个穿支代表了胸大肌肌瓣内侧移位的血管蒂。
