南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (5): 754-759.doi: 10.12122/j.issn.1673-4254.2021.05.17

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旋髂深动脉穿支的解剖与旋髂深动脉穿支嵌合髂骨皮瓣修复下颌骨复合缺损

陈永锋，洪 虓，刘 亮，展昭均，李孝亮，蒲春华，陈士文，廖圣恺   

  • 出版日期:2021-05-20 发布日期:2021-06-11

Anatomy of the deep circumflex iliac artery perforators and reconstruction of complex mandibular defects with chimeric deep circumflex iliac artery perforator flap

  • Online:2021-05-20 Published:2021-06-11

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摘要： 目的 探讨旋髂深动脉（DCIA）穿支血管的解剖与如何提高以旋髂深动脉穿支嵌合髂骨皮瓣(DCIAPF)修复下颌骨复合缺损的临床应用效果。方法 对6具12侧乳胶灌注动脉血管的成人标本进行解剖，显露DCIA及其穿支血管，观察穿支血管的起始部位、分布、数量及走向，并测量其起始处血管外径。结合解剖学结果和影像学检查，并在数字化手术导板辅助下，设计及切取DCIAPF，修复4例下颌骨体部及软组织复合缺损。结果 DCIA穿支血管分为腹壁肌支、肌骨支和肌皮穿支。腹壁肌支全由DCIA的腹股沟段发出的占66.7%，腹股沟段和髂骨段均有穿支发出的占33.3%。肌骨支全由髂嵴内段发出占75%，腹股沟段和髂嵴内段均有穿支发出的占25%，且发自腹股沟段的穿支均为1支。肌皮穿支为1支的占58.3%，为2支的占41.7%。临床应用4例DCIAPF均成活，供区伤口恢复良好。术后1月，患者面部外形及口腔形态恢复满意，咬合关系良好，供区无明显功能障碍，影像学检查示下颌骨缺损重建效果好。结论 熟悉DCIA穿支血管的解剖特点，结合影像学检查，在数字化外科技术辅助下，有助于更好的切取DCIAPF和修复下颌骨（体部或下颌角）及口腔软组织缺损。

关键词: 旋髂深动脉；穿支嵌合皮瓣；下颌骨缺损；数字化外科；修复重建

Abstract: Objective To investigate the anatomy of the perforator vessels of the deep circumflex iliac artery (DCIA) and the techniques for repairing mandibular complex defect using chimeric deep circumflex iliac artery perforator flap (DCIAPF). Methods We analyzed the origin, distribution, number and courses of the perforator vessels of the DCIA, and measured the outside diameters of the vessels at the origin in 6 adult cadaveric specimens (12 sides) with latex perfusion. From July, 2018 to September, 2019, based on the results of anatomical study and imaging findings and using the digital surgical guide plate, we harvested DCIAPF from 4 patients for repairing mandibular body or angle defects and oral soft tissue defects. Results The perforating vessels of the DCIA included abdominal muscular branches, osteomusculocutaneous branches and terminal musculocutaneous branches. The abdominal muscle branches originated from the DCIA inguinal segment in 4 and from botht he inguinal and iliac segments in 2 of the specimens. The osteomusculocutaneous branches all originated from the internal iliac crest in 75% and from both the inguinal and internal iliac crest segments in 25% of cases; the inguinal segment gave rise to only one perforating branch. The number of the musculocutaneous perforating branches was 1 (58.3% ) or 2 (41.7% ). In the 4 patients undergoing mandibular reconstruction, the DCIAPF survived in all cases with good recovery of the donor site wound. Satisfactory facial appearance with good oral morphology and occlusal relationship was achieved at 1 month postoperatively in all the patients. None of the patients experienced obvious functional abnormalities at the donor site, and imaging examination confirmed successful reconstruction of the oromandibular defects in all the cases. Conclusion A good understanding of the anatomic characteristics of the perforator vessels of the DCIA combined with imaging examinations and digital surgery technology facilitates the harvest of DCIAPF for repairing mandibular body or angle defects complicated by oral soft tissue defects.

Key words: deep circumflex iliac artery; chimeric perforator flap; mandibular defect; digital surgery; reconstruction