Kim Boktae, Inoue Yoshikazu, Imanishi Nobuaki, Chang Hak, Shimizu Yusuke, Okumoto Takayuki, Kishi Kazuo
Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Fujita Health University School of Medicine, Aichi, Toyoake, Japan; Department of Anatomy, Keio University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea; and Department of Plastic and Reconstructive Surgery, University of the Ryukyus Hospital, Okinawa, Japan.
Plast Reconstr Surg Glob Open. 2017 Sep 19;5(9):e1476. doi: 10.1097/GOX.0000000000001476. eCollection 2017 Sep.
Pedicled periosteal flaps are commonly used for tissue defects between the base of the skull and the midfacial area. This study aimed to clarify the 3-dimensional vascular distribution of temporal region flaps.
Ten fresh cadavers were used. Full-thickness cranial flaps were elevated from the cranial bone and each layer was detached separately. Contrast enhancement of the full thickness of the scalp, macroscopic evaluation, and histologic analyses were performed. Radiographs were obtained and image analysis was performed using a 3-dimensional monitor.
The mean number of deep vessels extending from the parietal branch of the superficial temporal artery was 68.7, including 14.2 and 54.5 vessels on the proximal and distal sides, respectively. The mean number of deep vessels extending from the frontal branch of the superficial temporal artery was 71.6, including 17.6 and 54.0 vessels on the proximal and distal sides, respectively. There were significantly more perforating branches in the distal area than in the proximal area of both the frontal and parietal branches ( = 0.005). There was no significant difference in the number of perforating branches between the frontal and parietal branches.
Contrast-enhanced images of the loose areolar tissue and periosteal layers revealed vessels that extended radially. We successfully identified the 3-dimensional structure of the perforating vessels peripheral to the temporal fossa. Our findings provide a theoretical foundation for the feasibility of elevating a periosteal/loose areolar tissue flap with a reliable blood supply without sacrificing the temporal muscle.
带蒂骨膜瓣常用于颅骨底部和面部中部之间的组织缺损。本研究旨在阐明颞区皮瓣的三维血管分布。
使用10具新鲜尸体。从颅骨掀起全层颅骨瓣，并将各层分别分离。对头皮全层进行对比增强、宏观评估和组织学分析。获取X线片并使用三维显示器进行图像分析。
颞浅动脉顶支发出的深部血管平均数量为68.7条，近端和远端分别为14.2条和54.5条。颞浅动脉额支发出的深部血管平均数量为71.6条，近端和远端分别为17.6条和54.0条。额支和顶支的远端区域穿支数量均显著多于近端区域（P = 0.005）。额支和顶支的穿支数量无显著差异。
疏松结缔组织层和骨膜层的对比增强图像显示血管呈放射状延伸。我们成功识别了颞窝周围穿支血管的三维结构。我们的研究结果为在不牺牲颞肌的情况下掀起具有可靠血供的骨膜/疏松结缔组织瓣的可行性提供了理论基础。
