Reid C D, Taylor G I
Br J Plast Surg. 1984 Apr;37(2):194-212. doi: 10.1016/0007-1226(84)90010-9.
The precise vascular territory and the variations of the acromio-thoracic axis were investigated in a series of 60 fresh cadavers and 50 formalin fixed specimens using dissection, ink injection and barium radiographic studies. The sternocostal portion and the clavicular head of the pectoralis major were found to have virtually independent vascular and nerve supplies. The pectoral artery supplied the former, whereas the deltoid artery nourished the latter. The dominant supply from the pectoral artery to the rib cage was found to enter around the fourth rib in the mid clavicular line. This supply is associated with a previously undescribed origin of the pectoralis major muscle in this region. The supply to the sternum was determined as indirect via the captured territory of the internal mammary system. The dominant supply to the skin from the pectoral artery arose laterally along the free lower border of the muscle as fasciocutaneous branches. The deltoid artery supplies the skin over the shoulder by numerous small branches which emerge from the intramuscular septa of the deltoid muscle. In addition a large axial artery was noted. In most cases this arose from the deltoid artery or its acromial branch and coursed laterally. It is noteworthy that the majority of skin paddles of the pectoralis major myocutaneous flap currently used in clinical practice are designed medially and inferiorly around the perimeter of the muscle and onto the rectus sheath. In these situations such flaps are not supplied directly by the pectoral artery. In fact, they are supplied indirectly by cutaneous branches belonging to the internal mammary/superior epigastric system which are captured by arterial connections with the pectoral artery. These occur predominantly in the pectoralis major muscle. Suggestions, based on these anatomical studies, are offered to improve the versatility and safety of flaps designed in this area.
在60具新鲜尸体和50个福尔马林固定标本中，通过解剖、墨水注射和钡剂造影研究，对肩胸轴的精确血管分布区域及其变异情况进行了调查。发现胸大肌的胸肋部和锁骨头部实际上有独立的血管和神经供应。胸肩峰动脉供应前者，而三角肌动脉滋养后者。发现胸肩峰动脉对胸廓的主要供应在锁骨中线处围绕第四肋进入。这种供应与该区域胸大肌以前未描述的起源有关。对胸骨的供应经确定是通过胸廓内系统的捕获区域间接供应的。胸肩峰动脉对皮肤的主要供应沿着肌肉的自由下边界外侧以筋膜皮支的形式发出。三角肌动脉通过从三角肌肌间隔发出的许多小分支供应肩部皮肤。此外，还发现了一条大的轴型动脉。在大多数情况下，它起源于三角肌动脉或其肩峰支并向外侧走行。值得注意的是，目前临床实践中使用的胸大肌肌皮瓣的大多数皮瓣是围绕肌肉周边在内侧和下方设计并延伸至腹直肌鞘。在这些情况下，此类皮瓣并非直接由胸肩峰动脉供应。实际上，它们是由属于胸廓内/腹壁上系统的皮支间接供应的，这些皮支通过与胸肩峰动脉的动脉连接而被捕获。这些连接主要发生在胸大肌中。基于这些解剖学研究，提出了一些建议以提高该区域设计皮瓣的多功能性和安全性。
