• 蚌埠醫(yī)學(xué)院第一附屬醫(yī)院（安徽蚌埠，233004） 1 整形外科，2 介入科;

【摘 要】 目的 通過頸內(nèi)、外動(dòng)脈造影對滑車上動(dòng)脈分支血管進(jìn)行影像學(xué)研究，并設(shè)計(jì)改良額部皮瓣行鼻再造術(shù)。 方法 選用30例成人頸內(nèi)、外動(dòng)脈造影資料進(jìn)行血管三維成像，對滑車上動(dòng)脈分支（肌支和皮支）進(jìn)行研究，探討滑車上動(dòng)脈分支走行、層次以及與眶上動(dòng)脈的交通情況。根據(jù)影像學(xué)檢測結(jié)果臨床應(yīng)用滑車上動(dòng)脈分支設(shè)計(jì)額部皮瓣對11例鼻缺損患者行鼻再造術(shù)。其中男7例，女4例；年齡15～48歲，平均23歲。鼻缺損范圍3.0 cm × 2.5 cm～5.0 cm × 3.5 cm。 結(jié)果 頸內(nèi)動(dòng)脈造影和三維成像顯示，30例滑車上動(dòng)脈恒定出現(xiàn)，直徑（0.9 ± 0.6）mm；其中淺層皮支恒定出現(xiàn)，直徑（0.7 ± 0.3）mm；深層肌支4例缺失，直徑（0.5 ± 0.5）mm，走行于額肌間，長（32.0 ± 6.2） mm，分支間互有交通并與眶上動(dòng)脈亦有吻合。臨床應(yīng)用皮瓣均成活，無軟骨外露，外形良好。術(shù)后經(jīng)4個(gè)月～3年隨訪，鼻尖、鼻翼及鼻小柱外形接近正常，鼻高度和坡度適中，再造鼻質(zhì)地彈性良好，鼻孔無狹窄，通氣功能正常。 結(jié)論 影像學(xué)檢測結(jié)果佐證了滑車上動(dòng)脈存在恒定皮支，以其分支為血管蒂設(shè)計(jì)的額部皮瓣提高了鼻再造療效。

引用本文： 徐靜,張陽,謝波,李光早,張莉,黃鶴,高嵩,葛樹星. 滑車上動(dòng)脈的影像學(xué)研究及在鼻再造術(shù)中的應(yīng)用. 中國修復(fù)重建外科雜志, 2012, 26(1): 46-49. doi: 復(fù)制

1. Surg, 2011, 37(4): 519-523.
2. Plast Reconstr Surg, 2008, 121(6): 1956-1963.
3. dual forehead flap. Br J Plast Surg, 2000, 53(2): 261-264.
4. Plast Reconstr Surg, 2008, 121(6): 1956-1963.
5. Whitaber IS, Karoo RO, Spyrou G, et al. The birth of plastic surgery: the story of nasal reconstruction from the Edwin Smith Papyzus to the twenty-first century. Plastic Reconstr Surg, 2007, 120(1): 327-336.
6. Stephen JM, Vicent RH. Plastic Surgery. 2nd ed. Philadelphia: Saunders,.
7. 蔡曉燕, 黎志明. 滑車上靜脈在鼻缺損修復(fù)中的應(yīng)用解剖研究. 中國修復(fù)重建外科雜志, 2009, 23(2): 86-88.
8. Prado R, Allen S. Reconstruction of a multi-subunit nasal defect. Dermatol.
9. Reece EM, Schaverien M, Rohrich RJ. The paramedian forehead flap: a dynamic anatomical vascular study verifying safety and clinical implications.
10. Zuker RM, Capek L, de Haas W. The expanded forehead scalping flap: a new method of total nasal reconstruction. Plast Reconstr Surg, 1996, 98(1): 155-159.
11. Menick FJ. The use of skin grifts for nasal lining. Clin Plast Surg, 2001, 28(2): 311-321.
12. Furuta S, Hayashi M, Shinohara H. Nasal reconstruction with an expanded.
13. Shumrick KA, Smith TL. The anatomic basis for the design of forehead flaps in nasal reconstruction. Arch Otolaryngol Head Neck Surg, 1992, 118(4): 373-379.
14. 李青峰, 雷華, 顧斌, 等. 額部階梯狀皮瓣與肌、皮雙瓣鼻再造術(shù). 中華整形外科雜志, 2004, 20(5): 351-353.
15. Li QF, Xie F, Gu B, et al. Nasal reconstruction using a split forehead flap. Plast Reconstr Surg, 2006, 118(7): 154-1550．.
16. 王會(huì)勇, 李青峰, 顧斌, 等. 滑車上動(dòng)脈分支的解剖研究及在鼻再造中的應(yīng)用. 中華整形外科雜志, 2007, 23(6): 487-490.
17. 李光早, 徐靜, 熊竹友, 等. 滑車上血管蒂額部皮瓣轉(zhuǎn)移鼻再造術(shù). 中華醫(yī)學(xué)美容美學(xué)雜志, 2009, 15(2): 73-76.
18. 章宏偉, 姚剛, 聞國華, 等. 改良前額旁正中皮瓣在鼻缺損和再造中的臨床應(yīng)用. 中華整形外科雜志, 2010, 26(1): 1-4.
19. 錢云良, 章一新, 楊軍, 等. 逆行耳前耳廓復(fù)合組織瓣顯微移植再造鼻亞結(jié)構(gòu). 中國修復(fù)重建外科雜志, 2006, 20(12): 1186-1188.
20. Ullmann Y, Fodor L, Shoshani O, et al. A novel approach to the use of the paramedian forehead flap for nasal reconstruction. Plast Reconstr Surg, 2005, 115(5): 1372-1378.
21. Reece EM, Schaverien M, Rohrich RJ. The paramedian forehead flap: a dynamic anatomical vascular study verifying safety and clinical implications.
22. Gilman L, Fisher G. Adjunctive use of primary nasal tip closure to facilitate local flap closure of challenging nasal defects. Dermatol Surg, 2010, 36(12): 2053-2056.
23. Woodard CR, Park SS. Reconstruction of nasal defects 1.5 cm or smaller. Arch Facial Plast Surg, 2011, 13(2): 97-102.
24. : 541-542.
  1. 1. Surg, 2011, 37(4): 519-523.
  2. 2. Plast Reconstr Surg, 2008, 121(6): 1956-1963.
  3. 3. dual forehead flap. Br J Plast Surg, 2000, 53(2): 261-264.
  4. 4. Plast Reconstr Surg, 2008, 121(6): 1956-1963.
  5. 5. Whitaber IS, Karoo RO, Spyrou G, et al. The birth of plastic surgery: the story of nasal reconstruction from the Edwin Smith Papyzus to the twenty-first century. Plastic Reconstr Surg, 2007, 120(1): 327-336.
  6. 6. Stephen JM, Vicent RH. Plastic Surgery. 2nd ed. Philadelphia: Saunders,.
  7. 7. 蔡曉燕, 黎志明. 滑車上靜脈在鼻缺損修復(fù)中的應(yīng)用解剖研究. 中國修復(fù)重建外科雜志, 2009, 23(2): 86-88.
  8. 8. Prado R, Allen S. Reconstruction of a multi-subunit nasal defect. Dermatol.
  9. 9. Reece EM, Schaverien M, Rohrich RJ. The paramedian forehead flap: a dynamic anatomical vascular study verifying safety and clinical implications.
  10. 10. Zuker RM, Capek L, de Haas W. The expanded forehead scalping flap: a new method of total nasal reconstruction. Plast Reconstr Surg, 1996, 98(1): 155-159.
  11. 11. Menick FJ. The use of skin grifts for nasal lining. Clin Plast Surg, 2001, 28(2): 311-321.
  12. 12. Furuta S, Hayashi M, Shinohara H. Nasal reconstruction with an expanded.
  13. 13. Shumrick KA, Smith TL. The anatomic basis for the design of forehead flaps in nasal reconstruction. Arch Otolaryngol Head Neck Surg, 1992, 118(4): 373-379.
  14. 14. 李青峰, 雷華, 顧斌, 等. 額部階梯狀皮瓣與肌、皮雙瓣鼻再造術(shù). 中華整形外科雜志, 2004, 20(5): 351-353.
  15. 15. Li QF, Xie F, Gu B, et al. Nasal reconstruction using a split forehead flap. Plast Reconstr Surg, 2006, 118(7): 154-1550．.
  16. 16. 王會(huì)勇, 李青峰, 顧斌, 等. 滑車上動(dòng)脈分支的解剖研究及在鼻再造中的應(yīng)用. 中華整形外科雜志, 2007, 23(6): 487-490.
  17. 17. 李光早, 徐靜, 熊竹友, 等. 滑車上血管蒂額部皮瓣轉(zhuǎn)移鼻再造術(shù). 中華醫(yī)學(xué)美容美學(xué)雜志, 2009, 15(2): 73-76.
  18. 18. 章宏偉, 姚剛, 聞國華, 等. 改良前額旁正中皮瓣在鼻缺損和再造中的臨床應(yīng)用. 中華整形外科雜志, 2010, 26(1): 1-4.
  19. 19. 錢云良, 章一新, 楊軍, 等. 逆行耳前耳廓復(fù)合組織瓣顯微移植再造鼻亞結(jié)構(gòu). 中國修復(fù)重建外科雜志, 2006, 20(12): 1186-1188.
  20. 20. Ullmann Y, Fodor L, Shoshani O, et al. A novel approach to the use of the paramedian forehead flap for nasal reconstruction. Plast Reconstr Surg, 2005, 115(5): 1372-1378.
  21. 21. Reece EM, Schaverien M, Rohrich RJ. The paramedian forehead flap: a dynamic anatomical vascular study verifying safety and clinical implications.
  22. 22. Gilman L, Fisher G. Adjunctive use of primary nasal tip closure to facilitate local flap closure of challenging nasal defects. Dermatol Surg, 2010, 36(12): 2053-2056.
  23. 23. Woodard CR, Park SS. Reconstruction of nasal defects 1.5 cm or smaller. Arch Facial Plast Surg, 2011, 13(2): 97-102.
  24. 24. : 541-542.