Tang Maolin, Mao Yihua, Almutairi Khalid, Morris Steven F
Wenzhou, Zhejiang, China; and Halifax, Nova Scotia, Canada From the Department of Anatomy, Wenzhou Medical College, Wenzhou University-town, and the Departments of Anatomy and Neurobiology and Surgery, Dalhousie University.
Plast Reconstr Surg. 2009 Jun;123(6):1729-1738. doi: 10.1097/PRS.0b013e3181a3f376.
Three-dimensional evaluations of cutaneous perforator vessels provide useful clinical information to aid in the design of perforator flaps. By combining three-dimensional digital imaging and angiography, the authors developed a new three-dimensional visualization technique for vascular perforators. Their purpose was to produce a digitized model of the posterior leg to determine the anatomical relationships of perforators in each zone of the posterior leg.
Eight cadavers were injected with a modified lead oxide-gelatin mixture. Two cadavers were selected for three-dimensional reconstruction using a spiral computed tomography scanner and specialized volume-rendering software. Dissection, angiography, and photography of each layer were performed to outline the course of every perforator in the posterior leg. The area of the vascular territory supplied by each source vessel was calculated. Surface areas were measured using Scion Image software.
The arterial supply to the integument of the posterior leg was divided into proximal, middle, and distal zones. There were 13 +/- 2.3 perforators with diameters of greater than or equal to 0.5 mm; the average external diameter was 0.8 +/- 0.2 mm. Each perforator supplied an average area of 38 +/- 9.0 cm. Perforators from the popliteal artery were large and consistent and supplied an average area of 55 +/- 20 cm; there were multiple anastomoses between perforators from the popliteal, posterior tibial, and peroneal arteries. The distal zone received its arterial supply from two to three smaller septocutaneous perforators, which are arranged longitudinally in one to two parallel chains.
The posterior leg is an excellent donor site for local and distant flaps. Perforator flaps could be based in a variety of ways from each zone.
皮肤穿支血管的三维评估可为穿支皮瓣设计提供有用的临床信息。通过结合三维数字成像和血管造影技术，作者开发了一种用于血管穿支的新型三维可视化技术。他们的目的是制作小腿后部的数字化模型，以确定小腿后部各区域穿支的解剖关系。
对8具尸体注射改良的氧化铅-明胶混合物。选择2具尸体使用螺旋计算机断层扫描仪和专门的容积再现软件进行三维重建。对每一层进行解剖、血管造影和摄影，以勾勒小腿后部每个穿支的走行。计算每条源血管供应的血管区域面积。使用Scion Image软件测量表面积。
小腿后部皮肤的动脉供应分为近端、中部和远端区域。有13±2.3条直径大于或等于0.5mm的穿支；平均外径为0.8±0.2mm。每个穿支平均供血面积为38±9.0cm²。腘动脉发出的穿支粗大且恒定，平均供血面积为55±20cm²；腘动脉、胫后动脉和腓动脉发出的穿支之间存在多处吻合。远端区域由2至3条较小的肌间隔皮穿支供血，这些穿支纵向排列成1至2条平行链。
小腿后部是局部和远位皮瓣的理想供区。可根据每个区域以多种方式设计穿支皮瓣。
