同种异体头面部复合组织移植的解剖学基础研究

发布时间：2018-04-05 16:35

本文选题：颞浅动脉　切入点：面动脉　出处：《中南大学》2010年硕士论文

【摘要】： 研究目的：通过血管灌注,显微解剖的方法,研究颞浅动脉(superficial temporal artery, STA)、面动脉(facial artery, FA)主要走行、分支和其分支的大致供养范围,并解剖面部浅层结构,为同种异体颜面移植术的临床应用提供解剖学依据。同时,模拟以颞浅动脉为蒂的换脸术供体皮瓣的切取过程并施以灌注,借以验证在换脸术中以STA主干为蒂的可行性。研究方法： 1.采用以红色乳胶灌注的成人头部标本3个共6侧,解剖STA主干及主要分支并用游标卡尺、直尺、量角器等观测STA的走行、起始、分支及与周围神经血管的相互关系。对STA的起源、行程、分支等进行观测和必要的拍照。测量的指标主要有：STA浅出点至发出额支处的距离,STA浅出点处外径,STA发出额支处到腮腺上缘的距离,额支到眼外角点的距离,额支与STA主干所成角度,从额支起点至外眦上方转折处之间的直线距离及实际血管长度,颞浅动脉顶支与主干所成的角度以及STA主干、额支、顶支的起始处外径。同时从颌下缘开始显露面动脉到内眦的全过程,展示它的走行、分支和终末部分以及面横动脉、眶下动脉和眼动脉的吻合关系。 2.模拟在同种异体颜面移植术中以STA主干为主要供养动脉的供体复合瓣切取的手术过程,切取“供体”全面部皮瓣,并向其一侧颞浅动脉主干灌注亚甲蓝注射液,观察亚甲蓝灌注范围。3.采用经福尔马林固定的一个头部标本进行面部浅层结构的解剖,观察面浅层血管、神经、肌肉的分布、走行及其支配范围。研究结果： 1.STA主干浅出颞浅筋膜后分出额、顶二支。其中额支与STA主干向前上方走行。至外毗上方折向内上走行。在额部,额支又分为额眶支和额顶支。额眶支行向前下方,分布于前额部皮肤,额顶支行向后上方。顶支从颞浅动脉发出后与额支主干后行向后上方。面动脉在嚼肌的前缘绕下颌骨下缘向上进入面部,迂曲向上行进至距口角外,然后上升至鼻翼基底,在沿鼻外侧到达内眦,延续为内眦动脉。面动脉位于笑肌、颧大肌、颧小肌、提上唇肌、提上唇鼻翼肌的外侧束的深面和下颌骨、颊肌、提口角肌的浅面。双侧面动脉和颞浅动脉在面部有广泛的交通支。 2.从一侧颞浅动脉灌注亚甲蓝后,发现亚甲蓝从对侧颞浅动脉可以流出,切开对侧皮肤后可见皮下组织出现点状染色。被亚甲蓝灌注的范围包括灌注侧颞部、颧部、颊部以及眶周以及对侧颧部、颞部等。研究结论： STA主干解剖位置恒定、粗大,并有足够长的血管蒂。其分支与面动脉等血管有广泛的吻合,吻合单侧STA主干可保证大部分面部血供。用STA主干为蒂切取同种异体全面部皮瓣,具有操作简洁、迅速、安全、血供可靠的优点,值得在临床应用中推广。
[Abstract]:Objectives of the study:By means of blood vessel perfusion and microdissection, we studied the main route of superficial temporal artery, Stella, facial artery of facial artery, the general range of branches and their branches, and dissected the superficial structure of the face.To provide anatomic basis for the clinical application of facial allograft transplantation.At the same time, the procedure of transposition of donor flap pedicled with superficial temporal artery was simulated and perfused to verify the feasibility of using STA trunk as pedicle during facial replacement.Research methods:1.The main STA trunk and its main branches were dissected from 3 adult head specimens infused with red latex, and the walking, starting, branching and interrelation with peripheral nerve and blood vessels were observed by Vernier caliper, straight ruler and protractor.Observe the origin, itinerary and branch of STA and take necessary photos.The main indexes measured were the distance from the point from the superficial to the frontal branch of the STA and the distance between the external diameter of the superficial point of the STA and the superior parotid gland, the distance between the frontal branch and the outer corner of the eye, and the angle between the frontal branch and the main STA trunk, the distance between the frontal branch and the upper parotid gland, the distance between the frontal branch and the outer corner of the eye.The distance between the frontal branch and the turning point of the lateral canthus and the actual vascular length, the angle between the parietal branch and the trunk of the superficial temporal artery, and the outer diameter of the starting point of the STA trunk, the frontal branch and the parietal branch.At the same time, the whole process of facial artery to inner canthus was exposed from the lower margin of the jaw, and the anastomosis of the transverse facial artery, the infraorbital artery and the ophthalmic artery was demonstrated.2.In facial allograft transplantation, the STA trunk was used as the main supporting artery of the donor complex flap. The "donor" total facial flap was removed, and methylene blue injection was infused into one side of the main trunk of the superficial temporal artery.The range of methylene blue perfusion was observed.A head specimen fixed by formalin was used to dissect the superficial facial structure and to observe the distribution of the superficial blood vessels, nerves and muscles, the movement and the innervation area of the facial superficial blood vessels, nerves and muscles.Results of the study:1.STA trunk shallowly emerged from the superficial temporal fascia and divided into forehead and parietal branches.The frontal branch and the STA trunk go forward and upward.Go up to the outer side.In the frontal part, the frontal branch is divided into the frontal orbital branch and the frontal parietal branch.The frontoorbital branch is located forward and lower in the skin of the forehead, and the frontopietal branch is located at the top of the forehead.The parietal branch from the superficial temporal artery and the frontal branch from the back to the top.The facial artery enters the face at the anterior edge of the masseter muscle around the lower margin of the mandible, detours up to the angle of mouth, then rises to the base of the nasal wing and reaches the medial canthus along the lateral side of the nose, and continues to be the medial canthus artery.The facial artery is located on the deep side of the lateral bundle of the muscle of laugh, zygomaticus major, zygomaticus minor, levator labialis, the lateral bundle of the muscle of levator nasi and the superficial surface of the mandibular, buccal and levator muscles.Bilateral arteries and superficial temporal arteries have extensive communicating branches on the face.2.After perfusing methylene blue from one side of superficial temporal artery, it was found that methylene blue could flow out from the contralateral superficial temporal artery.The range of methylene blue perfusion includes the temporal, zygomatic, buccal, periorbital and contralateral zygomatic and temporal regions.The study concluded that:The anatomical position of STA trunk is constant, thick, and has long enough vascular pedicle.Its branches are widely anastomosed with facial artery and other vessels. Anastomosis of unilateral STA trunk can guarantee the majority of facial blood supply.Using STA trunk as pedicle to cut allogeneic total facial flap has the advantages of simple operation, rapid operation, safety and reliable blood supply, which is worth popularizing in clinical application.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R622;R322

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