Moon H K, Taylor G I
Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Ohio.
Plast Reconstr Surg. 1988 Nov;82(5):815-32. doi: 10.1097/00006534-198811000-00014.
Radiographic studies of the deep superior epigastric artery (DSEA) and its connections within the soft tissues of the abdominal wall were performed in 64 fresh cadavers. The patterns of anastomosis between the deep superior epigastric artery and the deep inferior epigastric artery (DIEA) were noted. Type I (29 percent) revealed a single deep superior epigastric artery and deep inferior epigastric artery, type II (57 percent) revealed a double-branched system of each vessel, and type III (14 percent) revealed a system of three or more major branches. In each case, the two systems were united by choke vessels in the segment of muscle above the umbilicus. The supply to the various transverse and vertical skin flaps from the deep superior epigastric artery was defined as a series of captured anatomic territories bounded by choke vessels. The upper transverse and vertical flaps had the best supply, and the TRAM flap had the most tenuous supply. Midline crossover occurs predominantly in the subdermal plexus and on the surface of the rectus sheath. Modifications of the design of the TRAM flap, the case for a delay procedure, the wisdom of including a strip of anterior rectus sheath, and the risks of splitting the muscle with respect to its nerve supply and vascular patterns are discussed on an anatomic basis.
对64具新鲜尸体进行了腹壁软组织内腹壁上动脉（DSEA）及其连接的影像学研究。记录了腹壁上动脉与腹壁下动脉（DIEA）之间的吻合模式。I型（29%）显示单一的腹壁上动脉和腹壁下动脉，II型（57%）显示每条血管为双分支系统，III型（14%）显示三条或更多主要分支的系统。在每种情况下，两个系统在脐上方的肌肉段由缩窄血管相连。腹壁上动脉对各种横向和纵向皮瓣的供血被定义为由缩窄血管界定的一系列捕获的解剖区域。上横向和纵向皮瓣供血最佳，而横行腹直肌肌皮瓣（TRAM瓣）供血最薄弱。中线交叉主要发生在皮下丛和腹直肌鞘表面。基于解剖学基础讨论了TRAM瓣设计的改进、延迟手术的情况、包含一条腹直肌前鞘条带的合理性以及就其神经供应和血管模式而言劈开肌肉的风险。
