Vigato Enrico, De Antoni Eleonora, Tiengo Cesare, Porzionato Andrea, Tortorella Cinzia, Governa Maurizio, Macchi Veronica, De Caro Raffaele
Department of Plastic and Surgery and Burn Center, A.O.U.I of Verona, Italy.
Institute of Human Anatomy, Department of Neuroscience, University of Padova, Italy.
Microsurgery. 2018 Jan;38(1):76-84. doi: 10.1002/micr.30214. Epub 2017 Aug 2.
The superior (SGA) and the inferior gluteal artery (IGA) perforator flaps are widely used in pressure-sore repair and in breast reconstruction. The aim was to exhaustively depict the topographical anatomy of the whole system of perforators in the buttock.
Eighty lower-extremity computed tomographic angiography (CTA) of patients (20 males/20 females, mean age 61-years old, range 38-81) were considered. The source artery, location, type, and caliber of gluteal perforators were analyzed. The location of perforators was reproduced using a standardized two-dimensional grid on the coronal plane, centered onto defined bone landmarks. We defined "radiosome" the cutaneous vascular territory of a source artery inferred through the representation of its whole perforator system at the exit point through the deep fascia.
A mean number of 25.6 ± 5.7 perforators in the gluteal region was observed, distributed as follows: 11.6 ± 4.8(45.2%) from SGA; 7.9 ± 4.5(30.8%) from IGA; 1.5 ± 0.8(5.8%) from fifth lumbar artery; 1.2 ± 0.8(4.7%) from internal pudendal artery; 1.2 ± 1(4.8%) from lateral circumflex femoral artery; 0.3 ± 0.7(1.2%) from circumflex iliac superficial artery. At least one large (internal diameter > 1 mm) SGA septocutaneous perforator was present in 77.5% of patients.
The gluteal region is vascularized by perforators of multiple source arteries. Septocutaneous perforators of SGA and IGA were planned along a curve drawn from the posterior-superior border of the iliac crest to the greater trochanter. The lumbar artery perforators are clustered over the apex of the iliac crest; the internal pudendal artery perforators are clustered medially to the ischiatic tuberosity. Contributions can also come from the sacral and superficial circumflex iliac arteries.
臀上动脉（SGA）穿支皮瓣和臀下动脉（IGA）穿支皮瓣广泛应用于压疮修复及乳房重建。目的是详尽描述臀部穿支血管整个系统的局部解剖结构。
纳入80例患者的下肢计算机断层血管造影（CTA）资料（男性20例/女性20例，平均年龄61岁，范围38 - 81岁）。分析臀穿支血管的供血动脉、位置、类型及管径。穿支血管的位置通过在冠状面上以特定骨标志为中心的标准化二维网格进行重现。我们将通过其在穿出深筋膜处的整个穿支系统表现推断出的一条供血动脉的皮肤血管区域定义为“放射体”。
观察到臀区平均穿支血管数为25.6 ± 5.7支，分布如下：臀上动脉发出11.6 ± 4.8支（45.2%）；臀下动脉发出7.9 ± 4.5支（30.8%）；第5腰动脉发出1.5 ± 0.8支（5.8%）；阴部内动脉发出1.2 ± 0.8支（4.7%）；旋股外侧动脉发出1.2 ± 1支（4.8%）；旋髂浅动脉发出0.3 ± 0.7支（1.2%）。77.5%的患者至少有1支粗大（内径>1 mm）的臀上动脉肌间隔皮穿支。
臀区由多条供血动脉的穿支血管供血。臀上动脉和臀下动脉的肌间隔皮穿支沿从髂嵴后上缘至大转子所画的曲线进行规划。腰动脉穿支聚集在髂嵴顶部；阴部内动脉穿支聚集在坐骨结节内侧。骶动脉和旋髂浅动脉也有供血。
