Hallock G G, Rice D C
Dorothy Rider Pool Microsurgery and Laser Laboratory, Allentown, PA, USA.
Plast Reconstr Surg. 1995 Jul;96(1):111-8. doi: 10.1097/00006534-199507000-00017.
Despite an extensive knowledge of the anatomic nuances of the rectus abdominis muscle and corresponding relationship to the vascularization of the skin of the abdomen, the clinical outcome when used as a musculocutaneous flap cannot always be predictable. Only a few human physiologic studies have been attempted to explain this discrepancy. Further laboratory investigations of the anatomy and physiology of the rat transverse rectus abdominis musculocutaneous (TRAM) flap suggest that this is a safer, comparable, yet inexpensive animal model for studying further the dynamics of this flap. By caliber and course, the major source vessel to the rectus abdominis muscle in the Sprague-Dawley rat enters superiorly as the cranial epigastric artery, which is a continuation of the internal thoracic (mammary) artery. Anatomic dissections in 13 rats revealed, on average, that 4.7 +/- 0.97 large musculocutaneous perforators emanated from each cranial epigastric artery at regular intervals which then proceeded directly to the overlying abdominal integument. Just below the umbilicus, a watershed is formed by small "choke" anastomoses to a frequently vestigial caudal epigastric artery or, more commonly, a true anastomosis with a branch of the deep circumflex iliac artery. In 10 additional rats, TRAM flaps encompassing the skin of the entire abdominal wall were then elevated so as to rely on a single pedicle, alternating randomly from either source. By laser Doppler flowmetry, blood flow by means of the larger-caliber superior pedicle exceeded twice that of the subservient inferior pedicle.(ABSTRACT TRUNCATED AT 250 WORDS)
尽管对腹直肌的解剖细微差别及其与腹部皮肤血管化的对应关系有广泛了解，但将其用作肌皮瓣时的临床结果并非总是可预测的。仅有少数人体生理学研究试图解释这种差异。对大鼠腹直肌横行肌皮瓣（TRAM瓣）的解剖学和生理学进行的进一步实验室研究表明，这是一种更安全、可比且成本低廉的动物模型，可用于进一步研究该皮瓣的动态变化。从管径和走行来看，Sprague-Dawley大鼠腹直肌的主要供血血管是从上方向下进入的腹壁上动脉，它是胸廓内（乳腺）动脉的延续。对13只大鼠进行的解剖显示，平均每条腹壁上动脉每隔一定距离会发出4.7±0.97支较大的肌皮穿支，这些穿支随后直接通向覆盖其上的腹部皮肤。在脐部下方，通过与通常退化的腹壁下动脉的小“阻塞”吻合或更常见的与旋髂深动脉分支的真正吻合形成一个分水岭。然后在另外10只大鼠中，掀起包含整个腹壁皮肤的TRAM瓣，使其仅依靠单一蒂部供血，蒂部来源随机交替。通过激光多普勒血流仪测量发现，管径较大的上方蒂部的血流量超过下方次要蒂部血流量的两倍。（摘要截取自250词）
