Shao Yuguo, Zhou Xiaoyun, Hu Xiuquan
Department of Breast, the International Peace and Maternal and Child Health Hospital, Shanghai, P R China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2006 Sep;20(9):877-80.
To investigate the location of the artery correlated with rectus abdominis musculocutaneous flap in order to promote the reconstruction of the breast after radical mastectomy for breast cancer.
An anatomic study was carried out on 15 cadavers of 30 sides, which were immersed in paraformaldehyde less than six months. Whole thorax-epigastric wall was cutterd, which scale was from subclavian as upper limit to inguinal ligament, the lower limit across left and right of middle axillary. Veins or arteries of inferior epigastric and internal thorax in hang were injected with red or blue ink to show all of vessel branches.
The external diameters of both the superior epigastric arteries and inferior vessels were 1.87 +/- 0.28 mm and 2.25 +/- 0.32 mm respectively. The myocutaneous arteries from inferior abdomen vessels had an intensive horizontal distribution on hilum. The perforators significantly decreased but could be found to pass through anterior rectus sheath in Rand. The distances between lateral perforators and I , II and III parts in external edge of anterior rectus sheath were 1.22, 1.46 and 1.57 cm, respectively; and the distances between medial perforators and I, II, and III parts at median line were 1.54, 1.62, 1.66 cm. Perforators were more thick and intensive near hilum than in other part. The subcostal arteries derived from inferior abdomen artery and 1.25 +/- 0.37 cm away from costal arch. After dividing into subcostal artery, the outer diameter of 67 percent of subcostal artery was bigger than that of inferior abdomen arteries. The branches of subcostal arteries were distributed at the 2/3 lateral rectus abdominis, forming an extensive choke anastomosis system with intercostal anterior artery and vessels supplied diaphragmatic muscle. The rectus abdominis at the level of xyphoid was supplied by a branch came from inferior thorax artery, which diverged epigastric vessels at the same time.
During the process of making the inferior transverse rectus abdominis musculocutaneous flap base on superior epigastric vessels and superior rectus abdominis, reservation of pro-theca edge 1 cm of rectus abdominis can protect inferior abdomen artery from injury. Reservation of more than 2 cm pro-theca and rectus abdominis below costal arch at the flag will protect effectively subcostal artery from injury. No damage of subcostal arteries can influence the survival of musculocutaneous flap.
探讨与腹直肌肌皮瓣相关动脉的位置，以促进乳腺癌根治术后乳房再造。
对15具尸体共30侧进行解剖学研究，尸体均浸泡于甲醛中不足6个月。将整个胸腹壁自锁骨下至上为上限、腹股沟韧带至腋中线左右为下限进行切割。向悬垂的腹壁下静脉或动脉及胸廓内动静脉注入红或蓝色墨水以显示所有血管分支。
腹壁上动脉和腹壁下动脉外径分别为（1.87±0.28）mm和（2.25±0.32）mm。来自腹壁下血管的肌皮动脉在脐部有密集的水平分布。穿支显著减少，但在Rand区可发现其穿过腹直肌前鞘。外侧穿支与腹直肌前鞘外侧缘Ⅰ、Ⅱ、Ⅲ部的距离分别为1.22、1.46和1.57cm；内侧穿支与中线处Ⅰ、Ⅱ、Ⅲ部的距离分别为1.54、1.62、1.66cm。穿支在脐部附近比其他部位更粗且密集。肋下动脉起自腹壁下动脉，距肋弓1.25±0.37cm。肋下动脉分出后，67%的肋下动脉外径大于腹壁下动脉。肋下动脉分支分布于腹直肌外侧2/3，与肋间前动脉及供应膈肌的血管形成广泛的吻合支系统。剑突水平的腹直肌由来自胸廓下动脉的一支供应，该支同时分出腹壁血管。
以上腹壁血管和上腹部腹直肌为蒂制作下腹直肌肌皮瓣过程中，保留腹直肌前鞘边缘1cm可保护腹壁下动脉不受损伤。保留肋弓下2cm以上前鞘及腹直肌可有效保护肋下动脉不受损伤。不损伤肋下动脉可影响肌皮瓣存活。
