The Study Of Relationship Between Vessels' 3-D Reconstruction And Blood Supply Of Thinning Flap On Anterolateral Thigh

The application of thin flap is a kind of development tendency in the flap surgery. In recent years, the application of thin pattern of anterolateral thigh flap was reported increasing gradually. But the morbidity rate after the flap transplants was high, especially in aspects of repairing the defect of maxillofacial region and corpus linguae reconstruction. Recently, the focus to resolve this problem was on the protection of the flap perforating branch artery pedicel. The fat anadesma islet of perforating branch blood vessel pedicel in central part radius 2 cm was cut by microdissection method to protect perforating branch pedicel inside of central part from damage. But this method of microdissection is only in providing the central district of blood vessel pedicel with blood. Some problems was still unresolved up to now, for example, how to insure blood supply in surroundings district of flap or that in beyond to perforating branch blood vessel pedicel, especially in the prediction of thinness flap of survival area, in designing flap to insure its blood supply, and in the thinness or size of the flap. That is one main reason of the thin anterolateral thigh flap being not enough to be applied in clinic.Based on the applied anatomy, the study utilized digital image and imageology to learn the morphology and function of different thickness of the antero- lateral thigh flap blood vessel, at the same time, laser-Doppler technique was used in monitoring Skin blood priming volume to discuss the effect of the far side of the skin flap and near side perforating branch blood vessel, pro- anadesma cutaneous branches and post- anadesma cutaneous branches, adip- anadesma blood vessel comm on flap every region skin priming volume etc.Objectives1. To observe the course, anastomosis, distribution, stereochemical structure of the arteries in the anterolateral thigh flap and provid morphology for clinic application.2. To observe the blood vessel's morphous by applying the technique of digitization image and imageology means and provide some important morphometric data about the anterolateral thigh flap.3. To observe the effects of blood vessels's communication in different layers of anterolateral thigh flap. To explore the hemodynamic change of the thin flap and provide the reference basis for the thin flap's thickness and scopeand operation method.4. To explore and establish a kind of operation contrive and operation method that can guarantee to thin flap's blood supply and raise to the rate of thin flap transplantation, make it been easy to expand.MethodsSix fresh and three formalin-fixed cadaver were dissected. All of them had no destroy and injury.1. Lead oxide-gelatin injection technique and three-dimensional reconstruction: Two fresh adult specimen and four fresh lower limbs were injected lead oxide-gelatin at femoral artery. 24 hours later, the specimens were scanned by CT.2. Macro-micro-dissection: To uncover the soft tissue of anterolateral region of thigh and mark the perforating branch artery (0.5cm) witn lead. The origin, caliber, course, anastomosis, distribution were observed.3. Take photography of X-ray: Before and after diessecting, the anterolateral thigh flap was taken photography of X-ray.4. Take photography of spiral-CT: Before and after diessecting, the anterolateral thigh flap was scanned by spiral-CT.5. Three-dimensional reconstruction: Three-dimensional reconstructions of vessels were made by CT and mimics with the CT-data.6. To monitor the volume of anterolateral thigh flap's blood flow by Penned monitor and observe the effect of communicating branches in the layer of aponeurosis.7. The operation design of thin anterolateral thigh flap: Based on the results of this article, we designed the operation method and used in clinical practice.Results1. The morphology study on perforating branches of anterolateral thigh flap1) The group of unthined flaps and the group of thined flaps remaining the branches in aponeurosis: Three-dimensional reconstruction of the 5 perforating branch arteries in this two groups displayed the arteries were about integrity and the arteries in the deep layer, the subdermal vascular plexus.2) The group of thined flaps unremaining the branches in aponeurosis: Three-dimensional reconstruction of the proximal part of anterolateral thigh flap just displayed the branches in the layer of aponeurosis and not displayed the subdermal vascular plexus. The scope is: the longth is the length of post branch in the layer of aponeurosis, the width is the length of cutaneous artery. Three-dimensional reconstruction of the distal part of anterolateral thigh flap not only displayed the branches in the layer of aponeurosis but also displayed the subdermal vascular plexus. The scope of the arteries distribution covered all over distal part of flap, which is about 16cm×12cm. The perforating branch arteries were all in one through the subdermal vascular plexus and independent each others.2. The X-ray study on perforating branches of thin anterolateral thigh flap1) The group of unthined flap: The X-ray of unthined flap displayed the frontal and post branches in the layer of aponeurosis, also the vascular plexus in the fat and subdermal layers. The frontal branches communicated with the lateral femoral circumflex artery and the lateral superior genicular artery. The post branches communicated with the deep femoral artery. The scope of single artery distribution is about 29.3cm~2～52.9cm~2. The branches corned from post branches were more, and the vascular plexus among them were thicker. But the scope of distribution was difficult to limit. The area that incised was about 26～30cm×16～21 cm.2) The group of thined flaps remaining the branches in aponeurosis: The proximal part of lateral femoral circumflex artery diverged perforating branches and descending branches, which liked a root. The scope of perforating branches distribution was identified and slender, about 6～13cm×2～3cm. The perforating branches of lateral femoral circumflex artery directly given out cutaneous arteries radiately, which liked spider telangiectasia. The cutaneous arteries were longer and thicker, the vascular plexus were liked cobweb. The cutaneous arteries given out the recurrent branches in the subepidermal layer, the number of recurrent branches was about 5～7, the scope was about 12cm×10cm. The frontal anadesma cutaneous branche, the longest branch of post anadesma cutaneous branches and the longest artery in the distal subcutaneouly layer formed a triangle in the middle part of anterolateral thigh flap, the scope was about 22cm×12cm. There was a block region between the perforating branches of lateral superior genicular artery and the perforating branches of quadriceps artery of femur. That was to say the limit between them was definite. While there were gross communicating branchs between the perforating branches of deep femoral artery and the post branches in the layer of aponeurosis.3) The measurements of arteries in the anterolateral thigh flapGroupⅠ: The external diameter of the artery in the dermis of proximal anterolateral thigh flap was 0.29～0.41 mm.GroupⅡ: The external diameter of the artery in the dermis of distal anterolateral thigh flap was 0.65～0.68mm.GroupⅢ: The circa anadesma rami impetus part blood vessel caliber 0.82-1.38 mm.GroupⅣ: The circa anadesma rami telo-part blood vessel calibel≈0.65-0.81 mm.The source artery of a skin artery (this is slightly) exist difference. The skin artery enter the shallow film, then send out anterior and posterior aponeurosis branch, which form "root beard" structure in the anterior thigh lateral region of middle and far section, send out the second class aponeurosis branch, the second class aponeurosis branch end distribute scatter in middle and far section of the flap. Morph and caliber size of subdermal vascular plexus of anterior thigh lateral region of middle and far section were near uniformity seen in X-ray3. A before outside side skin petal wears to pay three dimension reconstructions of artery with can see to turn the research1) 3D morph comparison of each branch in lateral femoral circumflex artery Three-dimensional reconstruction was carried started from each branch in lateral femoral circumflex artery, distribution area of three-dimensional reconstruction can be seen in accordance with visual image. Two methods show part hypoderma blood vessels of anterior and posterior aponeurosis branch and distal perforating branch, blood vessel morph of deep femoral artery can be show using the two methods. But it was not showed in proximal section of anterior thigh lateral region and perforating branch of lateral superior genicular artery. Major blood vessels anastomosis and blood supply is similar in each perforating branch of anterior thigh lateral region flap.2) blood vessel three-dimensional structure of superior skin artery in lateral femoral circumflex artery.Its perforating branch area was about 30 cm×20 cm. There was higher density in central region. Skin artery perforating branch pedicel was located in above-mid 1/4 of central region. Blood vessel three-dimensional structure in surrounding region showed network. Abundant blood vessel and multilevel branch were seen from lateral view. Adjust parameter of three-dimensional reconstruction can reconstruct major and adjacent blood supply area of different perforating branch artery.4. A before outside side skin petal afferent blood dynamics first step research(preliminary study)1) Effect of perporating branch pedicel blood supply of descending branch in lateral femoral circumflex artery alone on skin priming volume of flap.2) Effect of clipped anadesma branch of anterior femoral lateral region flap on skin priming volume of flap.Compared with control group, skin priming volume of clipped anadesma branch in proximal region was no significance between two groups. But skin priming volume in distal region was significant between two groups.3) Effect of blockade ramus communicans in fat anadesma layer between distal and proximal perforating branch pedicel on skin priming volume of flap of distal and proximal perforating branch pedicel blood supply alone.Compared with control group, skin priming volume of clipped anadesma branch in proximal region was no significance between two groups. But skin priming volume in distal region was significant between two groups.ConclusionStruction characteristic of the vessels' 3D morph on the anterolateral thigh, it is useful for application in thinning flap on the anterolateral thigh...