Rozen Warren M, Garcia-Tutor Emilio, Alonso-Burgos Alberto, Corlett Russell J, Taylor G Ian, Ashton Mark W
Department of Anatomy and Cell Biology, Jack Brockhoff Reconstructive Plastic Surgery Research Unit, The University of Melbourne, Parkville, Victoria, Australia.
Clin Anat. 2009 Oct;22(7):815-22. doi: 10.1002/ca.20851.
The anterior abdominal wall integument is frequently used in a range of reconstructive flaps. These tissues are supplied by the deep and superficial inferior epigastric arteries (DIEA and SIEAs) and the deep and superficial superior epigastric arteries (DSEA and SSEAs). Previous abdominal wall surgery alters this vascular anatomy and may influence flap design. One hundred and sixty-eight patients underwent abdominal wall computed tomographic angiography (CTA) for preoperative imaging. Fifty-eight of these patients had undergone previous abdominal surgery, and were assessed for scar pattern and relationship to the course and distribution of all major axial vessels and perforators. Two cadaveric abdominal wall specimens with midline abdominal scars underwent contrast injection of the DIEAs and DSEAs, with subsequent CTA. The course and distribution of all cutaneous vessels were assessed. In all clinical and cadaveric cases, the vasculature of the abdominal wall had been altered by previous surgery. In the clinical cases, vascular architecture was universally altered in the region of the scar, often modifying the filling patterns of the abdominal wall and occasionally precluding the use of an abdominal wall flap. In both cadaveric specimens, regions of non-filling were evident upon contrast injection, highlighting the angiosomes not supplied by the DIEA or DSEA. Previous abdominal wall surgery necessarily alters the vascular architecture of the abdominal wall, and may alter the source vessels supplying cutaneous tissues. CTA was useful in identifying and delineating these changes, and may be used as a preoperative tool in this role.
前腹壁皮肤经常用于一系列重建皮瓣。这些组织由腹壁下深动脉和浅动脉（DIEA和SIEA）以及腹壁上深动脉和浅动脉（DSEA和SSEA）供血。既往腹壁手术会改变这种血管解剖结构，并可能影响皮瓣设计。168例患者接受了腹壁计算机断层血管造影（CTA）以进行术前成像。其中58例患者曾接受过腹部手术，并对其瘢痕模式以及与所有主要轴型血管和穿支血管的走行及分布的关系进行了评估。对两具具有腹部中线瘢痕的尸体腹壁标本进行腹壁下深动脉和腹壁上深动脉的造影剂注射，随后进行CTA检查。评估所有皮肤血管的走行及分布。在所有临床和尸体病例中，腹壁血管系统均因既往手术而改变。在临床病例中，瘢痕区域的血管结构普遍改变，常改变腹壁的充盈模式，偶尔会妨碍腹壁皮瓣的使用。在两具尸体标本中，造影剂注射后均可见无充盈区域，突出显示了未由腹壁下深动脉或腹壁上深动脉供血的血管体。既往腹壁手术必然会改变腹壁的血管结构，并可能改变供应皮肤组织的源血管。CTA有助于识别和描绘这些变化，并可作为术前工具发挥这一作用。
