Taylor G I, Gianoutsos M P, Morris S F
Department of Reconstructive Plastic Surgery, Royal Melbourne Hospital, Australia.
Plast Reconstr Surg. 1994 Jul;94(1):1-36. doi: 10.1097/00006534-199407000-00001.
In 1987, the results of a series of total-body investigations of the arterial system of the skin and underlying deep tissues were published. This resulted in the angiosome concept. In 1990, a similar series of studies of the venous network was published. In both investigations, it was noted that "vessels hitchhike with nerves." This anatomic study analyzes these neurovascular relationships in the skin and in the underlying muscles. Seven fresh human cadavers and nine animals were studied over a 2-year period. The entire integument of each and a total of 538 human and 72 animal muscles were removed and analyzed. Either the arterial or the venous system was injected with a radiopaque lead oxide mixture, and the dissected nerves were labeled with fine wires, being segregated later by a subtraction radiography technique. The results of these investigations are presented, with special emphasis placed on the design of long axial skin flaps placed along neurovascular systems and their relationship with the current design of skin flaps. The muscles are classified according to their extrinsic and intrinsic neurovascular supplies, and suggestions are made as to how they may or may not be subdivided into functional units for local and distant transfer. The cutaneous nerves, as well as the motor nerves of the muscles, were invariably accompanied by a longitudinal system of arteries and veins that often was the dominant supply to the region. Whether the nerves appeared together with the vessels, whether the nerves crossed them at an angle, or whether they approached the vessels from opposite directions, in each case the main trunk of the vessel or some of its branches soon "peeled off" to course parallel to the nerve. This information provides the basis for the design of long skin flaps placed along neurovascular systems. Indeed, it reveals that many of the current "axial" or "fasciocutaneous" skin flaps used in clinical practice are in fact neurovascular flaps. The muscles are classified into four types according to their extrinsic and intrinsic neurovascular supplies. Type I muscles are supplied by a single unbranched nerve. In type II muscles, the nerve branches before entering the muscle. Type III muscles receive multiple motor nerves from the same nerve trunk, and type IV muscles are supplied from multiple nerve trunks. Suggestions are made as to how muscles of each type may or may not be subdivided into functional neurovascular units for local and distant transfer.(ABSTRACT TRUNCATED AT 400 WORDS)
1987年，一系列关于皮肤及深层组织动脉系统的全身研究结果得以发表。由此产生了血管体概念。1990年，又发表了一系列关于静脉网络的类似研究。在这两项研究中，均注意到“血管与神经伴行”。本解剖学研究分析了皮肤及深层肌肉中的这些神经血管关系。在两年时间里，对7具新鲜人体尸体和9只动物进行了研究。去除并分析了每具尸体的整个体表以及总共538块人体肌肉和72块动物肌肉。向动脉系统或静脉系统注射不透射线的氧化铅混合物，并用细线标记解剖出的神经，随后通过减影放射摄影技术进行区分。展示了这些研究的结果，特别强调了沿神经血管系统设计的长轴型皮瓣及其与当前皮瓣设计的关系。根据肌肉的外在和内在神经血管供应情况对肌肉进行分类，并就如何将其分为或不分为用于局部和远距离转移的功能单位提出了建议。皮神经以及肌肉的运动神经总是伴随着纵向的动静脉系统，该系统往往是该区域的主要供应系统。无论神经是与血管一起出现，是与血管成一定角度交叉，还是从相反方向靠近血管，在每种情况下，血管的主干或其一些分支很快就会“分离”并与神经平行走行。这些信息为沿神经血管系统设计长皮瓣提供了依据。事实上，它表明临床实践中目前使用的许多“轴型”或“筋膜皮瓣”实际上都是神经血管皮瓣。根据肌肉的外在和内在神经血管供应情况，将肌肉分为四种类型。I型肌肉由单一的无分支神经供应。II型肌肉的神经在进入肌肉前分支。III型肌肉从同一神经干接受多条运动神经，IV型肌肉由多条神经干供应。就如何将每种类型的肌肉分为或不分为用于局部和远距离转移的功能性神经血管单位提出了建议。（摘要截选至400字）
