Cui HuaiRui, Ding MaoCao, Mao YiHua, Zhou Peng, Sun ChenYou, Tang MaoLin, Xu DaChuan
Department of Anatomy, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, China.
From the Department of Anatomy, School of Basic Medical Sciences, Nanfang Medical University, Guangzhou.
Ann Plast Surg. 2020 Dec;85(6):e48-e53. doi: 10.1097/SAP.0000000000002379.
The aim of the study was to provide an applied and digital anatomical basis of acquiring extended deep inferior epigastric perforator (DIEP) flaps for clinical use.
Five formalin-soaked specimens were received red latex injection and dissected by layers. The arteriography using the modified mixture of lead oxide-gelatin was performed on 10 adult cadavers that were serially scanned by a spiral computed tomography. The DIEPs were 3 dimensionally reconstructed by Mimics.
The medial row perforators of DIEP arteries are located in the medial 1/third of rectus abdominis muscle, and lateral row perforators in the lateral 1/third of the muscle. The perforators distribute mainly from the upper tendinous intersection of umbilicus to below umbilicus within 8.0 cm, especially 4.0 cm. There are constant diameter 0.8-mm perforators or greater accompanied with nerveswithin this region. The main perforators are shown by fast direct volume rendering (VR) reconstruction method, and 3-dimensional images of DIEPs are acquired by dynamic reconstruction (DR) method. Consecutively, the adjacent perforators can be combined freely and the position and anastomosis of extended branches can be easily observed. The extended DIEP flaps were designed by VR and DR methods.
The DIEPs can obtain large extended perforator flaps accompanied with nerves. The perforator close to the umbilicus should be selected while designing the DIEP flap. The 3-dimensional model of extended DIEP flaps can be established conveniently and intuitively by VR and DR methods of Mimics.
本研究旨在为获取用于临床的扩展型腹壁下深动脉穿支（DIEP）皮瓣提供应用和数字解剖学基础。
对5个经福尔马林浸泡的标本进行红色乳胶注射并逐层解剖。对10具成年尸体进行螺旋计算机断层扫描，然后使用改良的氧化铅-明胶混合物进行动脉造影。通过Mimics软件对腹壁下深动脉穿支进行三维重建。
腹壁下深动脉穿支的内侧排穿支位于腹直肌内侧1/3，外侧排穿支位于腹直肌外侧1/3。穿支主要分布于脐上腱划至脐下8.0 cm范围内，尤其是4.0 cm范围内。该区域内有直径恒定为0.8 mm或更大且伴有神经的穿支。主要穿支通过快速直接容积再现（VR）重建方法显示，通过动态重建（DR）方法获取腹壁下深动脉穿支的三维图像。连续地，相邻穿支可自由组合，且可轻松观察到扩展分支的位置和吻合情况。通过VR和DR方法设计扩展型腹壁下深动脉穿支皮瓣。
腹壁下深动脉穿支可获得带神经的大型扩展穿支皮瓣。设计腹壁下深动脉穿支皮瓣时应选择靠近脐部的穿支。通过Mimics软件的VR和DR方法可方便、直观地建立扩展型腹壁下深动脉穿支皮瓣的三维模型。
