本文選題：皮瓣 + 耳前區(qū)��； 參考：《第二軍醫(yī)大學(xué)》2010年碩士論文

【摘要】： 研究目的：觀察顳淺動(dòng)脈在耳前區(qū)的分支情況,為提高耳前區(qū)局部皮瓣的成活率和長寬比提供解剖學(xué)支持,并指導(dǎo)臨床應(yīng)用。 研究方法：①觀察范圍：后界為過耳屏點(diǎn)的垂線,前界為耳屏點(diǎn)前方3cm的垂線。上界為耳屏點(diǎn)上方3cm的水平線,下界為耳屏點(diǎn)下方7cm的水平線。②用乳膠灌注10%甲醛溶液固定的頭部標(biāo)本10具,進(jìn)行大體解剖,觀察顳淺動(dòng)脈在耳前區(qū)分支的起始位置、走行方向及分布區(qū)域。③用死亡6小時(shí)以內(nèi)的新鮮尸體頭部標(biāo)本2具制作透明標(biāo)本(面部軟組織全層透明),測量顳淺動(dòng)脈在耳前區(qū)分支的分布面積。 研究結(jié)果： 耳前區(qū)皮膚及皮下組織的血液主要由顳淺動(dòng)脈及其分支,如顴眶動(dòng)脈、顳淺動(dòng)脈耳屏前皮支、面橫動(dòng)脈等供應(yīng)。顴弓上方區(qū)域主要由顴眶動(dòng)脈供應(yīng)。顴弓下方區(qū)域由下頜角與外眥點(diǎn)的連線分成兩部分：后上方由顳淺動(dòng)脈耳屏前皮支和顴眶動(dòng)脈主干向下的分支供應(yīng),前下方由面橫動(dòng)脈的小分支供應(yīng)。以上動(dòng)脈及其分支之間有豐富的吻合。 顴眶動(dòng)脈大多數(shù)起源于顳淺動(dòng)脈的主干,起始點(diǎn)距耳屏點(diǎn)約7mm,沿顴弓上緣向眶外側(cè)前行,走行中分為上下兩支,分別供應(yīng)上瞼和下瞼的眼輪匝肌。顴眶動(dòng)脈主干在走行過程中,分別向上方和下方發(fā)出小的分支,供應(yīng)相鄰的皮膚及皮下組織。 顳淺動(dòng)脈在耳屏前有恒定的皮支發(fā)出。該皮支出現(xiàn)率100%,起始點(diǎn)位于耳屏點(diǎn)下方38.17±3.26(mm),起始點(diǎn)直徑0.61±0.27(mm)。該動(dòng)脈在腮腺后方向上走行,于耳屏前穿出SMAS層,穿出點(diǎn)在耳屏點(diǎn)前下方13.15±1.56(mm),穿出點(diǎn)處的血管直徑平均0.53±0.12(mm)。該皮支穿出SMAS層后分成2-3支,與過耳屏點(diǎn)的垂線成約30。角向下分布于腮腺淺面的皮下組織及皮膚,分布范圍為18.64±2.32(cm2),并與面橫動(dòng)脈、顴眶動(dòng)脈、面動(dòng)脈等動(dòng)脈的分支有豐富的吻合。 顳淺動(dòng)脈耳屏前皮支在以往的文獻(xiàn)中未見詳細(xì)描述。該動(dòng)脈屬于顳淺動(dòng)脈的分支,起始點(diǎn)直徑約0.6mm,在血供類型上,屬于動(dòng)脈皮支。因該動(dòng)脈恒定地于耳屏前穿出SMAS供應(yīng)耳屏前及其下方的皮膚及皮下組織,故我們稱其為顳淺動(dòng)脈耳屏前皮支。 面橫動(dòng)脈在耳前區(qū)主要走行于SMAS深面,行至耳前區(qū)前下方時(shí)發(fā)出分支垂直穿過SMAS層次,然后逐級分支,形成數(shù)個(gè)終末支供應(yīng)皮膚及皮下組織,這些終末支供應(yīng)范圍較小,相互之間吻合豐富。 結(jié)論：耳前區(qū)皮膚及皮下組織的血液主要由顳淺動(dòng)脈及其分支顴眶動(dòng)脈、顳淺動(dòng)脈耳屏前皮支、面橫動(dòng)脈等供應(yīng),上述動(dòng)脈之間吻合豐富。其中,顳淺動(dòng)脈耳屏前皮支在以往的文獻(xiàn)中未見詳細(xì)描述。該皮支出現(xiàn)率高,SMAS穿出點(diǎn)位置恒定,供應(yīng)范圍較大,臨床上利用該皮支可在耳前區(qū)形成半島狀軸型皮瓣或島狀皮瓣,用以修復(fù)周圍組織缺損。
[Abstract]:Objective: to observe the branches of superficial temporal artery in preauricular region and to provide anatomical support for improving the survival rate and aspect ratio of the local flap. Methods: the range of observation: the posterior boundary is the perpendicular line of the trapezoid point and the front boundary is the perpendicular line of 3cm in front of the auricular point. The upper boundary was the horizontal line of 3cm above the auricular point, and the lower boundary was the horizontal line .2 of 7cm below the auricular point. 10 head specimens fixed with 10% formaldehyde solution were perfused with latex. The initial position of the branches of the superficial temporal artery in the preauricular region was observed. In the direction and distribution area, 2 fresh cadaveric head specimens within 6 hours of death were used to make transparent specimens (the whole layer of facial soft tissue transparency), and the distribution area of superficial temporal artery branches in the preauricular region was measured. Results: the blood of skin and subcutaneous tissue in preauricular area was mainly supplied by superficial temporal artery and its branches, such as zygomatic-orbital artery, anterior cutaneous branch of superficial temporal artery and transverse facial artery. The area above the zygomatic arch is mainly supplied by the zygomatic-orbital artery. The area below the zygomatic arch is divided into two parts by the line between the mandibular angle and the outer canthus: the anterior cutaneous branch of the superficial temporal artery and the main branch of the zygomatic-orbital artery are supplied from the anterior cutaneous branch of the superficial temporal artery and the main branch of the zygomatic-orbital artery, and the inferior part is supplied by the small branch of the transverse facial artery. There is abundant anastomosis between the above arteries and their branches. Most of the zygomatic-orbital arteries originated from the main trunk of the superficial temporal artery, and the starting point was about 7 mm from the point of the auricle, and along the superior edge of the zygomatic arch to the lateral side of the orbit, there were two branches in the middle of the line, supplying the orbicularis oculi muscle of the upper eyelid and the lower eyelid, respectively. The zygomatic-orbital artery sends out small branches to the upper and lower, supplying adjacent skin and subcutaneous tissue. The superficial temporal artery has a constant cutaneous branch in front of the auricle. The appearance rate of the cutaneous branch is 100%, and the starting point is 38.17 鹵3.26 (mm), below the auricular point. The diameter of the starting point is 0.61 鹵0.27 (mm). The artery runs upwards behind the parotid gland and penetrates the SMAS layer in front of the tragus. The average diameter of the vessel at the point of perforation of 13.15 鹵1.56 (mm), in front of the auricular point is 0. 53 鹵0. 12 (mm). The skin branch is divided into 2-3 branches after the SMAS layer is perforated, which is about 30% of the vertical line across the auricular point. The angle was distributed downwards in the subcutaneous tissue and skin of the superficial parotid gland, with a range of 18.64 鹵2.32 (cm2), with abundant anastomosis with the branches of the transverse facial artery, the zygomatic-orbital artery and the facial artery. The anterior cutaneous branch of the superficial temporal artery is not described in detail in previous literature. The artery is a branch of the superficial temporal artery with a diameter of about 0.6 mm and belongs to the cutaneous branch of the artery in the type of blood supply. SMAS is used to supply the skin and subcutaneous tissue before and below the auricle, so we call it the cutaneous branch of the superficial temporal artery. The transverse facial artery mainly runs in the anterior ear area on the deep side of the SMAS. When it reaches the anterior and inferior preauricular area, it sends out branches perpendicular to the SMAS layer, then branches step by step, forming several terminal branches to supply the skin and subcutaneous tissue, and the supply range of these terminal branches is relatively small. There is a rich correspondence between each other. Conclusion: the blood of the skin and subcutaneous tissue in the preauricular area is mainly supplied by the superficial temporal artery and its branches, zygomatic-orbital artery, the anterior cutaneous branch of the superficial temporal artery and the transverse facial artery, and the anastomosis between the above arteries is abundant. Among them, the superficial temporal artery was not described in detail in previous literature. The location of the perforating point of SMAS is constant and the supply range is large. The skin branch can be used to form a peninsular axial flap or island flap in the preauricular area to repair the peripheral tissue defects.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R322

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