Tremblay Cécilia, Grabs Detlev, Bourgouin Daniel, Bronchti Gilles
Département d'anatomie, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
Département de chirurgie, Service de chirurgie vasculaire et thoracique, Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec and Vascular Surgery division, University of Montreal, Montreal, Qurebec, Canada.
J Vasc Surg. 2016 Sep;64(3):757-64. doi: 10.1016/j.jvs.2015.04.385. Epub 2015 Dec 22.
The purpose of this anatomic study was to describe the cutaneous vascularization of the femoral triangle and its variation to evaluate the potential consequences of the classic incisions used in vascular surgery. The ultimate goal was to suggest surgical approaches that would take into account the vascularization of the inguinal region to potentially reduce the vascular lesions and wound complications at the groin.
The cutaneous arteries of the femoral triangle were studied in 11 lower limbs from 6 human embalmed cadavers. The technique included embalming of the cadavers, radiopaque latex injection, radiographs, and anatomic dissection.
The comparison of the vascular patterns revealed that despite the high variability of the arborization of the cutaneous arteries, their distribution patterns share many characteristics. The main vascularization of the femoral triangle comes from three arteries: the superficial circumflex iliac, the superficial epigastric, and the external pudendal. The first two arteries originate generally through a common trunk that buds laterally from the femoral artery at about 1.5 cm below the inguinal ligament. This study shows that the classic vertical incision at the groin would lead to damage of the cutaneous branches that cross over the femoral artery in its proximal part (the superficial epigastric artery in 82% and the common trunk of the superficial epigastric and circumflex iliac arteries in 18%); these lesions could lead to the postsurgical disruption of the dermal blood flow.
The classic incisions could disrupt the cutaneous blood supply and thus increase the risk of tissue necrosis around the wound, explaining the observed postsurgical complications and infections. We propose to lower the vertical incision to start 2 cm under the inguinal ligament to reduce lesions of the cutaneous arteries and the potential devascularization of the wounds.
本解剖学研究旨在描述股三角的皮肤血管分布及其变异情况，以评估血管外科中经典切口可能产生的后果。最终目标是提出手术入路，该入路应考虑腹股沟区的血管分布，以潜在地减少腹股沟处的血管损伤和伤口并发症。
对6具防腐处理的人体尸体的11条下肢的股三角皮肤动脉进行了研究。该技术包括尸体防腐处理、不透射线乳胶注射、X线片检查和解剖 dissection。
血管模式的比较显示，尽管皮肤动脉分支高度变异，但其分布模式具有许多共同特征。股三角的主要血管供应来自三条动脉：旋髂浅动脉、腹壁浅动脉和阴部外动脉。前两条动脉通常起源于一个共同的主干，该主干在腹股沟韧带下方约1.5厘米处从股动脉外侧发出。本研究表明，腹股沟处的经典垂直切口会导致在股动脉近端交叉的皮肤分支受损（82%为腹壁浅动脉，18%为腹壁浅动脉和旋髂浅动脉的共同主干）；这些损伤可能导致术后真皮血流中断。
经典切口可能会破坏皮肤血液供应，从而增加伤口周围组织坏死的风险，这解释了观察到的术后并发症和感染。我们建议将垂直切口降低至在腹股沟韧带下方2厘米处开始，以减少皮肤动脉损伤和伤口潜在的缺血。
