肌内神经血管同时显示方法的研究及其在临床常用肌肉上的应用
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摘要
一、研究目的
随着临床外科学尤其是显微外科的发展,吻合血管和神经的游离组织移植手术越来越广泛,为了达到重建受区功能和避免供区功能障碍的目的,肌肉的部分移植也变得越来越重要,这就需要我们尽可能详细地了解肌内神经和血管在肌肉内的分布、走行,以及它们之间的相互关系。研究肌内神经分布的方法有解剖、计算机重建和Sihler's肌内神经染色法。前两种方法存在着许多不足之处,但Sihler's染色技术能在保持肌肉大体形态的情况下使整个标本变得透明或者半透明,将神经主干及其分支染成蓝紫色,神经在肌肉内的分布及走行清晰可见,被认为是研究肌内神经的理想方法。研究肌内血管分布的方法主要是血管灌注造影剂,在X线下拍片显示。造影剂有很多,应用较多的是硫酸钡和氧化铅,但由于氧化铅的毒性,使得硫酸钡成为主要造影剂,配合钼靶拍照,使得结果清晰明了。以前学者研究肌内神经和血管时都是分开进行的,也就是在一块肌肉上研究肌内神经,而在另外一块肌肉上研究肌内血管,这样就不能准确地反映两者之间的关系。也有学者报道了在同一块肌肉上研究肌内神经和血管的方法,但是没有达到理想的效果。本研究旨在探讨在同一块肌肉上研究肌内神经和血管分布的方法,并在临床常用肌瓣上进行应用。
二、研究方法
方法一：家兔5只过量麻醉处死后,经腹主动脉向远侧灌注硫酸钡乳胶。乳胶凝固后分离出股薄肌、股二头肌和腓肠肌,继续进行Sihler's肌内神经染色。具体步骤如下：(1)固定(Fixation):10%的甲醛溶液固定标本3周,液体变混浊时更换液体；(2)浸软和除色素(Maceration and Depigmentation):固定后的组织在流水下冲洗半小时,置入3%氢氧化钾(每100毫升加入3%双氧水0.2毫升),2-3天换液体一次直至肌肉淡黄色褪尽,肌肉发白呈半透明,此过程一般需要2-3周；(3)脱钙(Decalcification):肌肉流水下冲洗半小时入溶液,每5天换液一次,脱钙后的肌肉会丧失透明度或皱缩,此过程需要2-3周；(4)染色(Staining):脱钙后的肌肉蒸馏水浸泡1小时,中间更换蒸馏水2次,浸入Sihler'sⅡ溶液,此过程约需2-3周；(5)脱色(Destaining):染色后,肌肉重新入Sihler'sⅠ溶液中(液体变成黄褐色时及时更换新的Sihler'sⅠ溶液),当肌肉纤维脱色,神经主干及肌肉内分支变成蓝紫色时停止,此过程约需20小时；(6)中和(Neutralization):脱色后的肌肉蒸馏水浸泡1小时,入0.05%碳酸锂溶液(需要加热才能溶解)中浸泡2小时,中间轻轻搅动数次；(7)透明(Clearing):中和后的肌肉逐渐入40%,60%,80%,100%甘油中,每一个浓度浸泡3-4天;(8)保存：最后标本避光保存于100%甘油中(加入少量的麝香草酚)。染色结束后,将标本放置于有机玻璃托盘,标本边缘空白处放置两枚金属标记物,在保持肌肉形态不变的情况下分别进行肌内神经光学背光拍照和钼靶拍照,得到图片A和B,最后在计算机上根据金属标志物将两幅图片完全重叠,画出肌内血管和神经的走行分布模式图,达到在同一块肌肉上同时显示肌内神经和血管的目的。
方法二：1、家兔5只过量麻醉处死后,经腹主动脉向远侧灌注半透明红色乳胶。乳胶凝固后分离出股薄肌、股二头肌和腓肠肌。2、新鲜童尸3具,经腹主动脉分别向近侧和远侧灌注半透明红色乳胶。乳胶凝固后分离出背阔肌和股薄肌。将以上分离出的肌肉标本继续进行Sihler's肌内神经染色。染色步骤同上。染色结束后,在X线观片灯上可以清楚地看到肌内神经和血管,神经显示为蓝紫色,血管显示为红色。这样就能直观地显示神经和血管的准确信息以及它们之间的相互关系,达到了在同一块肌肉的同一张照片上同时显示肌内神经和肌内血管的目的。
三、结果
方法一中所得到的肌肉标本的图片A和图片B清晰明了,从图片A中能看到肌内神经和肌内血管的信息,图片B中的线条信息全部是肌内血管的分支信息,通过图片重叠,可以将图片A中有关血管的信息辨别出来,剩余的线条信息就是肌内神经的信息。方法二所得到的图片中肌内神经呈现蓝紫色,而肌内血管呈现红色,两者对比明显,使得结果更加准确直观。可以看出研究中的两种方法均能够在同一块肌肉上同时显示肌内神经和肌内血管的信息,清晰直观地显示神经和血管在肌肉内的走行以及两者之间的关系,而且通过这两种方法所得到的结果是一致的。它不仅适用于动物实验,在新鲜尸体上同样具有良好的结果：1、股深动脉分支与闭孔神经前支在进入股薄肌之前有一段相同的走行,两者共同组成血管神经蒂进入肌肉,在肌肉内的走行有明显的伴行关系,据此可以将股薄肌分成数个肌亚部。而股动脉分支则单独走行,与神经分支没有明显的伴行关系。2、胸背动脉和神经在背阔肌外即组成血管神经蒂,入肌点相同,入肌后各自的分支也相互伴行。据此我们可以将背阔肌分成3-4个肌肉亚部,每个肌肉亚部都有相对稳定的血管神经支配。
四、结论
1、本研究中所发现的两种方法均能达到了预期的目的。1、方法一中通过图片重叠,可以将肌内神经和肌内血管进行区别,绘制出肌内神经和血管的模式图。2、方法二中所得到的图片中,肌内神经呈现蓝紫色,而肌内血管呈现红色,两者颜色差别明显,使得结果更加准确直观。这两种方法均首次清晰直观地显示了同一块肌肉的肌内神经和血管的分布、走行以及两者之间的关系,相比以前的研究方式来说是一个重大创新,对于解剖学和临床医学具有重大而深远的意义。
2、这两种方法各有优势。当研究的肌肉比较小,或者肌肉比较扁阔时,建议用比较简单快捷的第二种方法；当研究的肌肉的体积比较大时,建议用第一种方法,以便能更好地区分肌内的神经和血管,使研究结果更加准确。
3、通过本研究中的方法对肌肉标本进行研究,具有重要的意义：
(1)是对解剖学的重要补充,完善解剖学的内容；
(2)指导临床选择理想的手术入路,避免不必要的神经血管损伤；
(3)对常用肌肉进行肌亚部划分,指导临床进行部分肌肉移植,既重建受区功能,又避免供区功能障碍；
(4)指导临床用同一块肌肉重建几个部位的功能,节约供区资源。
4、发现了一些肌内神经血管分布的规律：
(1)一块肌腹通常由一条神经主干支配,而血液供应通常有两条以上；
(2)当供应肌肉的血管有两条以上时,神经一般伴随肌肉的主要供应血管入肌；
(3)当神经血管共同组成神经血管蒂一起入肌时,它们进入肌肉后的分支,分布是紧密伴行的。
Background
Information on the distribution of intramuscular nerve and vessel branches within skeletal muscles is very important. This will be very useful to anatomists, physiologists and clinicians.
In the study of the intramuscular nerves, anatomical dissection has been the most commonly used method, but it has been limited by the inability to trace the nerve fibers from the extramuscular branches to the intramuscular terminal branches, as the latter are very fine and invisible even under the dissecting microscop. Furthermore, direct dissection would damage muscle fiber and disrupt the normal anatomical relationship between muscle and nerve fibers. Computer reconstruction of serial histological sections, another alternative, is not only time-consuming but also inaccurate due to distortion during tissue cutting, staining, orientation, and reconstruction. Sihler's stain technique was devised by Sihler in the 1800s. Researchers have modified the technique for various purposes and named it Sihler's stain in honor of its originator. Sihler's stain allows a whole specimen to be rendered relatively transparent, even if calcified, while the nerves were counterstained dark purple and were visible to their terminal branches. This is the best method for the intramuscular nerve studies.
In 1895, Roentgen discovered x-rays, and the first angiogram was produced by Haschek in 1896 after injecting chalk into the arteries of a cadaveric hand. From then on, all kinds of contrast media were tried, and the most useful of these methods have been barium sulfate and lead oxide injection techniques. Barium sulfate is a well-known radiographic contrast medium.In 1920, Gough injected barium sulfate mixed with gelatin or latex into vessels, and obtained success. In 1936, Salmon perfected the lead oxide technique to study muscle and skin vascular anatomy. So barium was soon replaced by lead oxide as the standard contrast agent for the study of very fine vascular networks. However, the barium sulfate technique has been reappraised lately. In 1999, some authors have improved the technique and obtained angiograms of very high quality by using mammography techniques. Nowadays, barium sulfate technique becomes the simple and effective method。
The intramuscular nerve and blood vessels were observed independently before 1994, when Taylor injected radiopaque lead oxide mixture into blood vessels, followed by the anatomical dissection of nerves. In each case the tissue was radiographed with and without the wire markers that was labeled for nerve branches. In this way, a subtraction picture could be obtained by superimposing the radiographs for those cases where it proved difficult to distinguish the wire marker from the vessels. Although the intramuscular nerve branches and blood vessels were displayed in same skeletal muscle, the nerve branches within the skeletal muscle was still shown by anatomical dissection,which has inability to trace the nerve fibers from extramuscular branches to the intramuscular terminator. Indeed, direct dissection would damage muscle fiber and disrupt the normal anatomical relationship between muscle and nerve fibers.
In this experiment, we will invent a method which can display the intramuscular nerve and vessel branches simultaneously.
Methods
Method one:Five rabbits were used in this study. After sacrifice with an overdose of chloral hydrate, the abdominal aorta and inferior vena cava were exposed through median abdominal incision. Subsequently, an abdominal aortic catheterization was performed downward to infuse physiological saline, whilst the inferior vena cava was opened. In the process, the lower limb was massaged to promote the removal of congestion. The infusion of physiological saline was stopped when the venous effluent was clear. The perfusion fluid which composed of liquid silicon rubber and superfine barium sulfate was perfused into the abdominal aorta using a 10ml syringe. The injection was maintained for additional one minute until the syringe underwent sentient elastic resistance. In this study, about 6.8ml mixture was used to each rabbit. After successful perfusion, the abdominal aorta was ligated to avoid outflow of mixture. Afterward, the specimens were immersed in 10% formaldehyde solution for two days, and then the gracilis, biceps femoris and gastrocnemius were incised and subjected to modified Sihler's stain. During the incision, the complete neurovascular pedicle must be reserved. After the procedur mentioned above, the specimens were then stained by Sihler's technique. In brief, muscle specimens were fixed in 10% unneutralized formalin for about 3 weeks. For further processing, muscles were washed with running water for about half an hour and then placed in a solution of 3% potassium hydroxide (KOH). For depigmentation,0.2 ml of 3% hydrogen peroxide was added per 100 ml of aqueous KOH. The total duration for immersion of the muscles was determined by the size of muscle and varied from 2 to 3 weeks. The specimens were then transferred into Sihler's Solution I which contained 1 part glacial acetic acid,2 parts glycerin, and 12 parts of 1% aqueous chloral hydrate for about 2 to 3 weeks. This solution was changed every 5 days. The specimens were then stained by immersing the whole muscle in Sihler's SolutionⅡ(which is composed of 1 part of Ehrlich's hematoxylin,2 parts of glycerin, and 12 parts of 1% aqueous chloral hydrate). Usually, the immersion time lasted 2 to 3 weeks. The specimens were then destained in Sihler's SolutionⅠand the solutions were changed when it became purple. When the muscle fiber becomes semitransparent and the intramuscular nerve branches become purple, they were washed in a solution containing 0.05% lithium carbonate for about 2 hours, so that the colors of the nerves changed from purple to deep blue. The specimens were then transferred to glycerin solutions of increasing concentration (40%,60% and 80% respectively, each transfer lasting for 3-4 days). Finally, specimens were stored in pure glycerin. After stained with modified Sihler's technique, the skeletal muscles were transferred onto a transparent organic glass tray. And then, two mental markers were placed above and below the specimens. Using a back-light, the muscle specimens were photographed with a digital camera. Subsequently, the specimens were radiographed with Molybdenum Target Photograph Machine to display distribution of the intramuscular arteries. In this process, the position of muscles and metal markers should be maintained. With the help of metal markers, the two photographs can be overlaped completely in a computer. So we can draw the schematic of intramuscular nerve and artery。
Method two:In this study, we substitute the fluid which composed of liquid silicon rubber and superfine barium sulfate with red semitransparent liquid silicon rubber. After stained with modified Sihler's technique, the muscle specimens were placed on a back-light viewbox, and were photographed with a digital camera. From the photograph, we can see clearly that the intramuscular nerve branches were stained purple blue and the artery branches red. Even we can place the muscle specimens into transparent airtight cans for clinical teaching.
Results
Method one:The results showed that the skeletal muscle were integrated and semitransparent in digital photos. And, the muscle fibers were shown as light blue. The intramuscular nerve branches were exhibited as purple blue or black, while the arterial branches were displayed in black. The distribution of arterial branches was revealed perspicuously in radiograph. Based on the superimposing of digital and radiographic pictures, the orientation and distribution of the intramuscular nerves and arterial branches were shown in one picture, which can enhance the understanding of accurate relationship between the muscle fibers, nerve branches and blood vessels.
Method two:Clear photographs were obtained. Intramuscular nerve branches were stained purple blue and artery branches were red.
Conclusions
1. The two methods were able to achieve the desired purpose. In methods one, with the help of radiophotograph and computer, intramuscular nerve branches can be distinguished from the artery branches, and so we can draw out the schematic of intramuscular nerve and artery. In the method two, the intramuscular nerve branches were stained purple blue and the intramuscular artery branches were red. This is a more direct-viewing method.
2. Both methods have their own advantages. When the muscles are relatively small or flat, it is recommended to use the second method which is relatively simple and fast. When the muscles are relatively large, it is recommended to use the first method in order to distinguish the intramuscular nerves and arteries clearly which could make the results more accurate.
3. There are important significances to study muscle specimens with our methods.
(1). This is an important complement to gross anatomy;
(2). Guide surgeons select the ideal surgical approach, avoiding unnecessary neurovascular injury;
(3). We can divide muscles into several departments. So we can transplants one of the departments, both repairing functions of the operation area and avoiding dysfunctions of donor site.
随着临床外科学尤其是显微外科的发展,吻合血管和神经的游离组织移植手术越来越广泛,为了达到重建受区功能和避免供区功能障碍的目的,肌肉的部分移植也变得越来越重要,这就需要我们尽可能详细地了解肌内神经和血管在肌肉内的分布、走行,以及它们之间的相互关系。研究肌内神经分布的方法有解剖、计算机重建和Sihler's肌内神经染色法。前两种方法存在着许多不足之处,但Sihler's染色技术能在保持肌肉大体形态的情况下使整个标本变得透明或者半透明,将神经主干及其分支染成蓝紫色,神经在肌肉内的分布及走行清晰可见,被认为是研究肌内神经的理想方法。研究肌内血管分布的方法主要是血管灌注造影剂,在X线下拍片显示。造影剂有很多,应用较多的是硫酸钡和氧化铅,但由于氧化铅的毒性,使得硫酸钡成为主要造影剂,配合钼靶拍照,使得结果清晰明了。以前学者研究肌内神经和血管时都是分开进行的,也就是在一块肌肉上研究肌内神经,而在另外一块肌肉上研究肌内血管,这样就不能准确地反映两者之间的关系。也有学者报道了在同一块肌肉上研究肌内神经和血管的方法,但是没有达到理想的效果。本研究旨在探讨在同一块肌肉上研究肌内神经和血管分布的方法,并在临床常用肌瓣上进行应用。
二、研究方法
方法一：家兔5只过量麻醉处死后,经腹主动脉向远侧灌注硫酸钡乳胶。乳胶凝固后分离出股薄肌、股二头肌和腓肠肌,继续进行Sihler's肌内神经染色。具体步骤如下：(1)固定(Fixation):10%的甲醛溶液固定标本3周,液体变混浊时更换液体；(2)浸软和除色素(Maceration and Depigmentation):固定后的组织在流水下冲洗半小时,置入3%氢氧化钾(每100毫升加入3%双氧水0.2毫升),2-3天换液体一次直至肌肉淡黄色褪尽,肌肉发白呈半透明,此过程一般需要2-3周；(3)脱钙(Decalcification):肌肉流水下冲洗半小时入溶液,每5天换液一次,脱钙后的肌肉会丧失透明度或皱缩,此过程需要2-3周；(4)染色(Staining):脱钙后的肌肉蒸馏水浸泡1小时,中间更换蒸馏水2次,浸入Sihler'sⅡ溶液,此过程约需2-3周；(5)脱色(Destaining):染色后,肌肉重新入Sihler'sⅠ溶液中(液体变成黄褐色时及时更换新的Sihler'sⅠ溶液),当肌肉纤维脱色,神经主干及肌肉内分支变成蓝紫色时停止,此过程约需20小时；(6)中和(Neutralization):脱色后的肌肉蒸馏水浸泡1小时,入0.05%碳酸锂溶液(需要加热才能溶解)中浸泡2小时,中间轻轻搅动数次；(7)透明(Clearing):中和后的肌肉逐渐入40%,60%,80%,100%甘油中,每一个浓度浸泡3-4天;(8)保存：最后标本避光保存于100%甘油中(加入少量的麝香草酚)。染色结束后,将标本放置于有机玻璃托盘,标本边缘空白处放置两枚金属标记物,在保持肌肉形态不变的情况下分别进行肌内神经光学背光拍照和钼靶拍照,得到图片A和B,最后在计算机上根据金属标志物将两幅图片完全重叠,画出肌内血管和神经的走行分布模式图,达到在同一块肌肉上同时显示肌内神经和血管的目的。
方法二：1、家兔5只过量麻醉处死后,经腹主动脉向远侧灌注半透明红色乳胶。乳胶凝固后分离出股薄肌、股二头肌和腓肠肌。2、新鲜童尸3具,经腹主动脉分别向近侧和远侧灌注半透明红色乳胶。乳胶凝固后分离出背阔肌和股薄肌。将以上分离出的肌肉标本继续进行Sihler's肌内神经染色。染色步骤同上。染色结束后,在X线观片灯上可以清楚地看到肌内神经和血管,神经显示为蓝紫色,血管显示为红色。这样就能直观地显示神经和血管的准确信息以及它们之间的相互关系,达到了在同一块肌肉的同一张照片上同时显示肌内神经和肌内血管的目的。
三、结果
方法一中所得到的肌肉标本的图片A和图片B清晰明了,从图片A中能看到肌内神经和肌内血管的信息,图片B中的线条信息全部是肌内血管的分支信息,通过图片重叠,可以将图片A中有关血管的信息辨别出来,剩余的线条信息就是肌内神经的信息。方法二所得到的图片中肌内神经呈现蓝紫色,而肌内血管呈现红色,两者对比明显,使得结果更加准确直观。可以看出研究中的两种方法均能够在同一块肌肉上同时显示肌内神经和肌内血管的信息,清晰直观地显示神经和血管在肌肉内的走行以及两者之间的关系,而且通过这两种方法所得到的结果是一致的。它不仅适用于动物实验,在新鲜尸体上同样具有良好的结果：1、股深动脉分支与闭孔神经前支在进入股薄肌之前有一段相同的走行,两者共同组成血管神经蒂进入肌肉,在肌肉内的走行有明显的伴行关系,据此可以将股薄肌分成数个肌亚部。而股动脉分支则单独走行,与神经分支没有明显的伴行关系。2、胸背动脉和神经在背阔肌外即组成血管神经蒂,入肌点相同,入肌后各自的分支也相互伴行。据此我们可以将背阔肌分成3-4个肌肉亚部,每个肌肉亚部都有相对稳定的血管神经支配。
四、结论
1、本研究中所发现的两种方法均能达到了预期的目的。1、方法一中通过图片重叠,可以将肌内神经和肌内血管进行区别,绘制出肌内神经和血管的模式图。2、方法二中所得到的图片中,肌内神经呈现蓝紫色,而肌内血管呈现红色,两者颜色差别明显,使得结果更加准确直观。这两种方法均首次清晰直观地显示了同一块肌肉的肌内神经和血管的分布、走行以及两者之间的关系,相比以前的研究方式来说是一个重大创新,对于解剖学和临床医学具有重大而深远的意义。
2、这两种方法各有优势。当研究的肌肉比较小,或者肌肉比较扁阔时,建议用比较简单快捷的第二种方法；当研究的肌肉的体积比较大时,建议用第一种方法,以便能更好地区分肌内的神经和血管,使研究结果更加准确。
3、通过本研究中的方法对肌肉标本进行研究,具有重要的意义：
(1)是对解剖学的重要补充,完善解剖学的内容；
(2)指导临床选择理想的手术入路,避免不必要的神经血管损伤；
(3)对常用肌肉进行肌亚部划分,指导临床进行部分肌肉移植,既重建受区功能,又避免供区功能障碍；
(4)指导临床用同一块肌肉重建几个部位的功能,节约供区资源。
4、发现了一些肌内神经血管分布的规律：
(1)一块肌腹通常由一条神经主干支配,而血液供应通常有两条以上；
(2)当供应肌肉的血管有两条以上时,神经一般伴随肌肉的主要供应血管入肌；
(3)当神经血管共同组成神经血管蒂一起入肌时,它们进入肌肉后的分支,分布是紧密伴行的。
Background
Information on the distribution of intramuscular nerve and vessel branches within skeletal muscles is very important. This will be very useful to anatomists, physiologists and clinicians.
In the study of the intramuscular nerves, anatomical dissection has been the most commonly used method, but it has been limited by the inability to trace the nerve fibers from the extramuscular branches to the intramuscular terminal branches, as the latter are very fine and invisible even under the dissecting microscop. Furthermore, direct dissection would damage muscle fiber and disrupt the normal anatomical relationship between muscle and nerve fibers. Computer reconstruction of serial histological sections, another alternative, is not only time-consuming but also inaccurate due to distortion during tissue cutting, staining, orientation, and reconstruction. Sihler's stain technique was devised by Sihler in the 1800s. Researchers have modified the technique for various purposes and named it Sihler's stain in honor of its originator. Sihler's stain allows a whole specimen to be rendered relatively transparent, even if calcified, while the nerves were counterstained dark purple and were visible to their terminal branches. This is the best method for the intramuscular nerve studies.
In 1895, Roentgen discovered x-rays, and the first angiogram was produced by Haschek in 1896 after injecting chalk into the arteries of a cadaveric hand. From then on, all kinds of contrast media were tried, and the most useful of these methods have been barium sulfate and lead oxide injection techniques. Barium sulfate is a well-known radiographic contrast medium.In 1920, Gough injected barium sulfate mixed with gelatin or latex into vessels, and obtained success. In 1936, Salmon perfected the lead oxide technique to study muscle and skin vascular anatomy. So barium was soon replaced by lead oxide as the standard contrast agent for the study of very fine vascular networks. However, the barium sulfate technique has been reappraised lately. In 1999, some authors have improved the technique and obtained angiograms of very high quality by using mammography techniques. Nowadays, barium sulfate technique becomes the simple and effective method。
The intramuscular nerve and blood vessels were observed independently before 1994, when Taylor injected radiopaque lead oxide mixture into blood vessels, followed by the anatomical dissection of nerves. In each case the tissue was radiographed with and without the wire markers that was labeled for nerve branches. In this way, a subtraction picture could be obtained by superimposing the radiographs for those cases where it proved difficult to distinguish the wire marker from the vessels. Although the intramuscular nerve branches and blood vessels were displayed in same skeletal muscle, the nerve branches within the skeletal muscle was still shown by anatomical dissection,which has inability to trace the nerve fibers from extramuscular branches to the intramuscular terminator. Indeed, direct dissection would damage muscle fiber and disrupt the normal anatomical relationship between muscle and nerve fibers.
In this experiment, we will invent a method which can display the intramuscular nerve and vessel branches simultaneously.
Methods
Method one:Five rabbits were used in this study. After sacrifice with an overdose of chloral hydrate, the abdominal aorta and inferior vena cava were exposed through median abdominal incision. Subsequently, an abdominal aortic catheterization was performed downward to infuse physiological saline, whilst the inferior vena cava was opened. In the process, the lower limb was massaged to promote the removal of congestion. The infusion of physiological saline was stopped when the venous effluent was clear. The perfusion fluid which composed of liquid silicon rubber and superfine barium sulfate was perfused into the abdominal aorta using a 10ml syringe. The injection was maintained for additional one minute until the syringe underwent sentient elastic resistance. In this study, about 6.8ml mixture was used to each rabbit. After successful perfusion, the abdominal aorta was ligated to avoid outflow of mixture. Afterward, the specimens were immersed in 10% formaldehyde solution for two days, and then the gracilis, biceps femoris and gastrocnemius were incised and subjected to modified Sihler's stain. During the incision, the complete neurovascular pedicle must be reserved. After the procedur mentioned above, the specimens were then stained by Sihler's technique. In brief, muscle specimens were fixed in 10% unneutralized formalin for about 3 weeks. For further processing, muscles were washed with running water for about half an hour and then placed in a solution of 3% potassium hydroxide (KOH). For depigmentation,0.2 ml of 3% hydrogen peroxide was added per 100 ml of aqueous KOH. The total duration for immersion of the muscles was determined by the size of muscle and varied from 2 to 3 weeks. The specimens were then transferred into Sihler's Solution I which contained 1 part glacial acetic acid,2 parts glycerin, and 12 parts of 1% aqueous chloral hydrate for about 2 to 3 weeks. This solution was changed every 5 days. The specimens were then stained by immersing the whole muscle in Sihler's SolutionⅡ(which is composed of 1 part of Ehrlich's hematoxylin,2 parts of glycerin, and 12 parts of 1% aqueous chloral hydrate). Usually, the immersion time lasted 2 to 3 weeks. The specimens were then destained in Sihler's SolutionⅠand the solutions were changed when it became purple. When the muscle fiber becomes semitransparent and the intramuscular nerve branches become purple, they were washed in a solution containing 0.05% lithium carbonate for about 2 hours, so that the colors of the nerves changed from purple to deep blue. The specimens were then transferred to glycerin solutions of increasing concentration (40%,60% and 80% respectively, each transfer lasting for 3-4 days). Finally, specimens were stored in pure glycerin. After stained with modified Sihler's technique, the skeletal muscles were transferred onto a transparent organic glass tray. And then, two mental markers were placed above and below the specimens. Using a back-light, the muscle specimens were photographed with a digital camera. Subsequently, the specimens were radiographed with Molybdenum Target Photograph Machine to display distribution of the intramuscular arteries. In this process, the position of muscles and metal markers should be maintained. With the help of metal markers, the two photographs can be overlaped completely in a computer. So we can draw the schematic of intramuscular nerve and artery。
Method two:In this study, we substitute the fluid which composed of liquid silicon rubber and superfine barium sulfate with red semitransparent liquid silicon rubber. After stained with modified Sihler's technique, the muscle specimens were placed on a back-light viewbox, and were photographed with a digital camera. From the photograph, we can see clearly that the intramuscular nerve branches were stained purple blue and the artery branches red. Even we can place the muscle specimens into transparent airtight cans for clinical teaching.
Results
Method one:The results showed that the skeletal muscle were integrated and semitransparent in digital photos. And, the muscle fibers were shown as light blue. The intramuscular nerve branches were exhibited as purple blue or black, while the arterial branches were displayed in black. The distribution of arterial branches was revealed perspicuously in radiograph. Based on the superimposing of digital and radiographic pictures, the orientation and distribution of the intramuscular nerves and arterial branches were shown in one picture, which can enhance the understanding of accurate relationship between the muscle fibers, nerve branches and blood vessels.
Method two:Clear photographs were obtained. Intramuscular nerve branches were stained purple blue and artery branches were red.
Conclusions
1. The two methods were able to achieve the desired purpose. In methods one, with the help of radiophotograph and computer, intramuscular nerve branches can be distinguished from the artery branches, and so we can draw out the schematic of intramuscular nerve and artery. In the method two, the intramuscular nerve branches were stained purple blue and the intramuscular artery branches were red. This is a more direct-viewing method.
2. Both methods have their own advantages. When the muscles are relatively small or flat, it is recommended to use the second method which is relatively simple and fast. When the muscles are relatively large, it is recommended to use the first method in order to distinguish the intramuscular nerves and arteries clearly which could make the results more accurate.
3. There are important significances to study muscle specimens with our methods.
(1). This is an important complement to gross anatomy;
(2). Guide surgeons select the ideal surgical approach, avoiding unnecessary neurovascular injury;
(3). We can divide muscles into several departments. So we can transplants one of the departments, both repairing functions of the operation area and avoiding dysfunctions of donor site.
引文
[1]Tamai S, Komatsu S, Sakamoto H, et al. Free muscle transplants in dogs, with microsurgical neurovascular anastomoses[J]. Plast Reconstr Surg,1970, 46(3):219-225.
[2]王炜,主编.整形外科学[M].杭州：浙江科学技术出版社,1999:225-340,806-821.
[3]郭恩覃,主编.现代整形外科学[M].北京：人民军医出版社,2000:65-69,188-238.
[4]江华,郭恩覃,季正伦,等.吻合血管神经游离展肌移植一期修复晚期面瘫[J].中华外科杂志,1992,30(7))：420-423.
[5]LETBETTER, William D. Influence of intramuscular nerve branching on motor unit organization in medial gastroenemius muscle[J]. Anat Rec,1974,178:402.
[6]Serlin DM, Schieber MH. Morphologic regions of the multitendoned extrinsic finger muscles in the monkey forearm[J]. Acta Anat (Basel),1993,146(4):255-266.
[7]Homma T, Sakai T. Thenar and hypothenar muscles and their innervation by the ulnar and median nerves in the human hand[J]. Acta Anat (Basel),1992, 145(1):44-49.
[8]Ying R, Zhang M, Han Y, et al. Computer 3-dimensional reconstruction of intraglandular lymph vessels and ductal systems of the human submandibular gland[J]. Acta Anat,1992,144(2):175-177.
[9]Sihler C. Uber Muskelspindeln und intramuskulare Nervenendigungen bei Schlangen und Froschen[J]. Arch Mikros Anat Entwickl,1895,46:709-723.
[10]Warton LR. A technique for studying the innervation of organs[J]. Anat Rec,1937, 67:469-475.
[11]Williams TW. A technique for the gross differential staining of peripheral nerves in cleared vertebrate tissue[J]. Anat Rec,1943,86:189-194.
[12]Freihofer WC. The Sihler technique of staining nerves for systematic study especially of fishes[J]. Copeia,1966,3:470-475.
[13]Wu BL, Sanders I. A technique for demonstrating the nerve supply of whole larynges[J]. Arch Otolaryngol Head Neck Surg,1992,118(8):822-827.
[14]Drake W,3rd, Li Y, Rothschild MA, et al. A technique for displaying the entire nerve branching pattern of a whole muscle:results in 10 canine posterior cricoarytenoid muscles[J]. Laryngoscope,1993,103(2):141-148.
[15]Liu J, Kumar VP, Shen Y, et al. Modified Sihler's technique for studying the distribution of intramuscular nerve branches in mammalian skeletal muscle[J]. Anat Rec,1997,247(1):137-144.
[16]于大志,江华,党瑞山,等.腹直肌肌皮瓣的应用解剖及其肌内神经分布[J].解剖学杂志,2007,30(6):777-779.
[17]Hua J, Kumar VP, Pereira BP, et al. Split flexor carpi radialis muscle[J]. Plast Reconstr Surg,1999,103(3):930-934.
[18]于大志,江华,党瑞山,等.临床常用肌瓣肌内神经分布的研究[J].中国临床解剖学杂志,2008,26(6):595-597.
[19]Chen G, Jiang H, Liu AT, et al. Neurovascular details about forearm muscles: applications in their clinical use in functional muscular transfer[J]. Surg Radiol Anat,2009,32(1):3-8.
[20]Haschek E, Linderthal OT. Ein Beitrag zur praktischen Verwerthung der Photographie nach Rontgen[J]. Wien Klin Wochenschr,1896,9:63.
[21]Gough JA. A method of injecting the blood-vessels for roentgenological studies and simultaneously embalming[J]. Anat Rec,1920,18(193).
[22]Salmon M. Arte'res des muscles de la te^te et du cou[J]. Paris:Masson,1936.
[23]Tan BK, Ng RTH, Tay NS. Tissue microangiography using a simplified barium sulphate cadaver injection technique[J]. Ann Acad Med Singapore,1999,28:152.
[24]Taylor GI, Gianoutsos MP, Morris SF. The neurovascular territories of the skin and muscles:anatomic study and clinical implications[J]. Plast Reconstr Surg,1994, 94(1):1-36.
[25]Yang D, Morris SF. Neurovascular anatomy of the rectus femoris muscle related to functioning muscle transfer[J]. Plast Reconstr Surg,1999,104(1):102-106.
[26]Sihler C. Ueber Muskelspindeln und intramuskulare nervenendigungen bei schlangen und froschen.[J]. Arch Mikros Anat Entwickl,1895,46:709-723.
[27]Liem RS, Douwe van Willigen J. In toto staining and preservation of peripheral nervous tissue[J]. Stain Technology,1988,63(2):113-120.
[28]Wu BL, Sanders I. A technique for demonstrating the nerve supply of whole larynges[J]. Arch Otolaryngol Head Neck Surg,1992,118(8):822-827.
[29]Gupta R, Nelson SD, Baker J, et al. The innervation of the triangular fibrocartilage complex:nitric acid maceration rediscovered[J]. Plast Reconstr Surg,2001, 107(1):135-139.
[30]李平,薛黔,等.Sihler肌内神经染色方法的探讨[J].遵义医学院学报,2001,24(4)：317-319.
[31]王启明,薛黔,杨胜波.Sihler's肌内神经染色法的再改良[J].遵义医学院学报,2003,26(4)：322-324.
[32]薛黔,李名扬.人腓肠肌外侧头亚部化的研究[J].遵义医学院报,1985,8(4):5-8.
[33]韩江全,薛黔,杨方玖,人三角肌的肌内神经分布与亚部划分及其临床意义[J].中国临床解剖学杂志,2004,22(3):269-270,281.
[34]陈刚,江华,林子豪,等.前臂伸肌内神经血管分布的解剖学研究及其临床意义[J].中国临床解剖学杂志,2006,24(6):595-599.
[35]张跃蓉,刘静.人翼外肌肌内神经肌梭的分布及其意义[J].中国临床解剖学杂志,2007,25(5)：525-527.
[36]吴聪,薛黔,杨方玖.人膈肌内神经分支分布[J].中国临床解剖学杂志,2005,23(4)：378-380.
[37]Yousif NJ, Matloub HS, Kolachalam R, et al. The transverse gracilis musculocutaneous flap[J]. Ann Plast Surg,1992,29(6):482-490.
[38]Hallock GG. Further experience with the medial circumflex femoral(GRACILIS) perforator free flap[J]. J Reconstr Microsurg,2004,20(2):115-122.
[39]Vranckx JJ, Misselyn D, Fabre G, et al. The gracilis free muscle flap is more than just a "graceful" flap for lower-leg reconstruction[J]. J Reconstr Microsurg,2004, 20(2):143-148.
[40]Kumar PA. Cross-face reanimation of the paralysed face, with a single stage microneurovascular gracilis transfer without nerve graft:a preliminary report[J]. Br J Plast Surg,1995,48(2):83-88.
[41]Wellisz T, Rechnic M, Dougherty W, et al. Coverage of bilateral lower extremity calcaneal fractures with osteomyelitis using a single split free gracilis muscle transfer[J]. Plast Reconstr Surg,1990,85(3):457-460.
[42]Kumar VP, Liu J, Lau HK, et al. Neurovascular supply of the gracilis muscle:a study in the monkey and human[J]. Plast Reconstr Surg,1998,101(7):1854-1860.
[43]Taylor GI, Cichowitz A, Ang SG, et al. Comparative anatomical study of the gracilis and coracobrachialis muscles:implications for facial reanimation[J]. Plast Reconstr Surg,2003,112(1):20-30.
[44]Schoeller T, Meirer R, Gurunluoglu R, et al. Gracilis muscle split into two free flaps[J]. J Reconstr Microsurg,2003,19(5):295-298.
[45]Elbarrany WG, Al-Hayani A, Softa S. The blood and nerve supply of the long head of the biceps femoris muscle; its possible use in dynamic neoanal sphincter[J]. West Afr J Med,2005,24(4):287-294.
[46]Cavadas PC, Sanz-Jimenez-Rico JR, Landin L, et al. Biceps femoris perforator free flap for upper extremity reconstruction:anatomical study and clinical series[J]. Plast Reconstr Surg,2005,116(1):145-152.
[47]Tsetsonis CH, Laoulakos DH, Kaxira OS, et al. The biceps femoris short head muscle flap:an experimental anatomical study[J]. Scand J Plast Reconstr Surg Hand Surg,2003,37(2):65-68.
[48]Puschmann H, Rahmanzadeh R, Gorkisch K. [Restorative surgery on the lower leg using muscular shifting grafts-anatomical and clinical aspects (author's transl)][J]. Aktuelle Traumatol,1980,10(5):281-285.
[49]Hersh CK, Schenck RC, Williams RP. The versatility of the gastrocnemius muscle flap[J]. Am J Orthop (Belle Mead NJ),1995,24(3):218-222.
[50]Tsai CC, Lin TM, Lai CS, et al. Nonendoscopic harvest of the gastrocnemius muscle flap through a small incision[J]. Ann Plast Surg,2001,47(2):134-137.
[51]Seify H, Jones G, Sigurdson L, et al. Endoscopic harvest of four muscle flaps:safe and effective techniques[J]. Ann Plast Surg,2002,48(2):173-179.
[52]Jastrzebski J, Huber P. [Reconstruction in Achilles tendon rupture and simultaneous covering of a skin and soft tissue defect using the myocutaneous gastrocnemius sliding flap][J]. Handchir Mikrochir Plast Chir,1987, 19(5):281-283.
[53]Russell RC, Pribaz J, Zook EG, et al. Functional evaluation of latissimus dorsi donor site[J]. Plast Reconstr Surg,1986,78(3):336-344.
[54]Fraulin FO, Louie G, Zorrilla L, et al. Functional evaluation of the shoulder following latissimus dorsi muscle transfer[J]. Ann Plast Surg,1995,35(4):349-355.
[55]De Azevedo JF. Pectoralis minor flaps:an experimental study and clinical applications of osteomuscular, osteomyocutaneous, and myocutaneous models[J]. Head Neck Surg,1987,9(4):211-222.
1. Bardoel JW, Stadelmann WK, Perez-Abadia GA, Galandiuk S, Zonnevijlle ED, Maldonado C, Stremel RW, Tobin GR, Kon M, Barker JH (2001) Dynamic rectus abdominis muscle sphincter for stoma continence:an acute functional study in a dog model. Plast Reconstr Surg 107:478-484
2. Boyle KE, Moran ME, Calvano CJ, White MD, Reddy PP, Mehlhaff BA (1998) Endoscopic subcutaneous neurovascular lower-extremity myofascial flap harvesting for genitourinary reconstruction. J Endourol 12:187-191
3. Chambers JN, Purinton PT, Moore JL, Allen SW (1990) Treatment of trochanteric ulcers with cranial sartorius and rectus femoris muscle flaps. Vet Surg 19:424-428
4. Clavert P, Cognet JM, Baley S, Stussi D, Prevost P, Babin SR, Simon P, Kahn JL (2008) Anatomical basis for distal sartorius muscle flap for reconstructive surgery below the knee. Anatomical study and case report. J Plast Reconstr Aesthet Surg 61:50-54
5. De Azevedo JF (1987) Pectoralis minor flaps:an experimental study and clinical applications of osteomuscular, osteomyocutaneous, and myocutaneous models. Head Neck Surg 9:211-222
6. Fattah A, Figus A, Mathur B, Ramakrishnan VV (2008) The transverse myocutaneous gracilis flap:technical refinements. J Plast Reconstr Aesthet Surg doi:10.1016/j.bjps.2008.10.015
7. Gravvanis A, Caulfield RH, Mathur B, Ramakrishnan V (2009) Management of inguinal lymphadenopathy:immediate sartorius transposition and reconstruction of recurrence with pedicled ALT flap. Ann Plast Surg 63:307-310
8. Giilekon N, Peker T, Turgut HB, Anil A, Karakose M (2007) Qualitative comparison of anatomical microdissection, Sihler's staining and computerized reconstruction methods for visualizing intramuscular nerve branches. Surg Radiol Anat 29:373-378
9. Harrison DH (2002) The treatment of unilateral and bilateral facial palsy using free muscle transfers. Clin Plast Surg 29:539-549, vi
10. Jiang H, Guo ET, Ji ZL, Zhang ML, Lu V (1995) One-stage microneurovascular free abductor hallucis muscle transplantation for reanimation of facial paralysis. Plast Reconstr Surg 96:78-85
11. Kay S, Pinder R, Wiper J, Hart A, Jones F, Yates A (2009) Microvascular free functioning gracilis transfer with nerve transfer to establish elbow flexion. J Plast Reconstr Aesthet Surg doi:10.1016/j.bjps.2009.05.021
12. Lee JW, Lee YC, Chang TW (2008) Microvascularly augmented transverse rectus abdominis myocutaneous flap for breast reconstruction--reappraisal of its value through clinical outcome assessment and intraoperative blood gas analysis. Microsurg 28:656-662
13. Letbetter, William D (1974) Influence of intramuscular nerve branching on motor unit organization in medial gastroenemius muscle. Anat Rec 178:402
14. Liem RS, Douwe van Willigen J (1988) In toto staining and preservation of peripheral nervous tissue. Stain Technol 63:113-120
15.Lim AY, Pereira BP, Kumar VP, De Coninck C, Taki C, Baudet J, Merle M (2004) Intramuscular innervation of upper-limb skeletal muscles. Muscle Nerve 29:523-530
16. Liu J, Kumar VP, Shen Y, Lau HK, Pereira BP, Pho RW (1997) Modified Sihler's technique for studying the distribution of intramuscular nerve branches in mammalian skeletal muscle. Anat Rec 247:137-144
17.Michlits W, Gruber S, Windhofer C, Macheiner P, Walsh M, Papp C (2008) Reconstruction of soft tissue defects overlying the Achilles tendon using the super extended abductor hallucis muscle flap. J Trauma 65:1459-1462
18. Moinfar AR, Murthi AM (2007) Anatomy of the pectoralis minor tendon and its use in acromioclavicular joint reconstruction. J Shoulder Elbow Surg 16:339-346
19. Ortak T, Uraloglu M, Orbay H, Tekin F, Unlu RE, Sensoz O (2006) Transfer of innervated split latissimus dorsi free musculocutaneous flap for flexion and extension of the fingers. Ann Plast Surg 56:443-446
20. Peker T, Gulekon N, Turgut BH, Anil A, Karakose M, Mungan T, Danisman N (2006) Observation of the relationship between the shape of skeletal muscles and their nerve distribution patterns:a transparent and microanatomic study. Plast Reconstr Surg 117:165-176
21. Sihler C (1895) Ueber Muskelspindeln und intramuskulare nervenendigungen bei schlangen und froschen. Arch Mikros Anat Entwickl 46:709-723
22. Takeishi M, Fujimoto M, Ishida K, Makino Y (2008) Muscle sparing-2 transverse rectus abdominis musculocutaneous flap for breast reconstruction:a comparison with deep inferior epigastric perforator flap. Microsurg 28:650-655
23. Terzi A, Luzzi L, Campione A, Gorla A, Calabro F (2009) The split latissimus dorsi muscle flap to protect a bronchial stump at risk of bronchial insufficiency. Ann Thorac Surg 87:329-330
24. Werker PM (2007) [Plastic surgery in patients with facial palsy]. Ned Tijdschr Geneeskd 151:287-294
25. Wong C, Saint-Cyr M (2009) The pedicled descending branch muscle-sparing latissimus dorsi flap for trunk and upper extremity reconstruction. J Plast Reconstr Aesthet Surg doi:10.1016/j.bjps.2009.01.059
26. Wu BL, Sanders I (1992) A technique for demonstrating the nerve supply of whole larynges. Arch Otolaryngol Head Neck Surg 118:822-827
27. Yercan HS, Ozalp T, Okcu G (2007) Reconstruction of diabetic foot ulcers by lateral supramalleolar flap. Saudi Med J 28:872-876
28.Ying R, Zhang M, Han Y, Wang G, Chen K, Cai Y (1992) Computer 3-dimensional reconstruction of intraglandular lymph vessels and ductal systems of the human submandibular gland. Acta Anat 144:175-177
[1]Hua J, En-tan G, Zheng-lun J, et al. One-stage microneurovascular free abductor hallucis muscle transplantation for the reanimation of facial paralysis[J]. Plast Reconstr Surg,1995,96(1):178-184.
[2]钟世镇.临床应用解剖学.北京：人民军医出版社,1998:797-799.
[3]Homma T, Sakai T. Thenar and hypothenar muscles and their innervation by the ulnar and median nerves in the human hand[J]. Acta Anat,1992,145:44-49.
[4]Serlin DM, Schieber MH. Morphologic regions of the multitendoned extrinsic finger muscles in the monkey forearm[J]. Acta Anat (Basel),1993,146(4):255-266.
[5]Wu BL, Sanders I. A technique for demonstrating the nerve supply of whole larynges[J]. Arch Otolaryngol Head Neck Surg,1992,118(8):822-827.
[6]Drake W,3rd, Li Y, Rothschild MA, et al. A technique for displaying the entire nerve branching pattern of a whole muscle:results in 10 canine posterior cricoarytenoid muscles[J]. Laryngoscope,1993,103(2):141-148.
[7]Sihler C. Ueber Muskelspindeln und intramuskulare nervenendigungen bei schlangen und froschen.[J]. Arch Mikros Anat Entwickl,1895,46:709-723.
[8]Liem RS, Douwe van Willigen J. In toto staining and preservation of peripheral nervous tissue[J], Stain Technol,1988,63(2):113-120.
[9]Liu J, Kumar VP, Shen Y, et al. Modified Sihler's technique for studying the distribution of intramuscular nerve branches in mammalian skeletal muscle[J]. Anat Rec,1997,247(1):137-144.
[10]Gupta R, Nelson SD, Baker J, et al. The innervation of the triangular fibrocartilage complex:nitric acid maceration rediscovered[J]. Plast Reconstr Surg,2001, 107(1):135-139.
[11]李平,薛黔,等.Sihler肌内神经染色方法的探讨[J].遵义医学院学报,2001,24(4):317-319.
[12]王启明,薛黔,杨胜波.Sihler's肌内神经染色法的再改良[J].遵义医学院学报,2003,26(4)：322-324.
[13]杜卓民.实用组织学技术(第二版).北京：人民卫生出版社,1998:36-37.
[14]李文,张赛霞.常用苏木素几种配方与染色结果的比较[J].解剖学杂志,2000,23(4):393-394.
[15]Sanders I, Mu L. Anatomy of the human internal superior laryngeal nerve[J]. Anat Rec, 1998,252(4):646-656.
[16]Zur KB, Mu L, Sanders I. Distribution pattern of the human lingual nerve[J]. Clin Anat, 2004,17(2):88-92.
[17]张跃蓉,刘静.人咬肌肌内神经的分布及临床意义[J].遵义医学院学报,2004,27(2)：106-108.
[18]Lim AY, Pereira BP, Kumar VP, et al. Intramuscular innervation of upper-limb skeletal muscles[J]. Muscle Nerve,2004,29(4):523-530.
[19]Gozil R, Kadioglu D, Calguner E, et al. Branching patterns of rabbit oculomotor and trochlear nerves demonstrated by Sihler's stain technique[J]. Biotech Histochem,2002, 77(1):21-25.
[20]吴聪,薛黔,杨方玖.人膈肌内神经分支分布[J].中国临床解剖学杂志,2005,23(4):378-380.
[21]张洪武,薛黔,杨方玖.人股直肌肌内神经分布和神经入肌点定位研究in human rectus femoris[J].遵义医学院学报,2006,29(2):111-113.
[22]Letbetter W. Influence of intramuscular nerve branching on motor unit organization in medial gastroenemius muscle[J]. Anat Rec,1974:178-202.
[23]English A, Letbetter W. Anatomy and innervation patterns of cat lateral gastrocnemius and plantaris muscles[J]. Am J Anat,1982,164:67-77.
[24]Kumar VP, Liu J, Lau HK, et al. Neurovascular supply of the gracilis muscle:a study in the monkey and human[J]. Plast Reconstr Surg,1998,101(7):1854-1860.
[25]Taylor G, Gianoutsos M, Morris S. The neurovascular territories of the skin and muscles:anatomic study and clinical implications[J]. Plast Reconstr Surg,1994, 94:1-36.
[26]Hua J, Kumar VP, Pereira BP, et al. Split flexor carpi radialis muscle[J]. Plast Reconstr Surg,1999,103(3):930-934.
[27]Lim AY, Kumar VP, Hua J, et al. The neuromuscular compartments of the flexor carpi ulnaris[J]. Plast Reconstr Surg,1999,103(3):1046-1051; quiz 1052, discussion 1053.
[28]陈刚,江华,林子豪,等.家兔小腿三头肌内神经和血管分布的研究[J].第二军医 大学学报,2005,26(1):38-40.
[29]Kierner AC, Zelenka I, Burian M. How do the cervical plexus and the spinal accessory nerve contribute to the innervation of the trapezius muscle? As seen from within using Sihler's stain[J]. Arch Otolaryngol Head Neck Surg,2001,127(10):1230-1232.
[30]Godat DM, Sanger JR, SD L. Detailed neurovascular anatomy of the serratus anterior muscle:implications for a functional muscle flap with multiple independent force vectors[J]. Plast Reconstr Surg,2004,114(1):21-31.
[31]陈刚,江华,林子豪,等.掌长肌内神经血管的解剖学观察及其临床意义[J].中国临床解剖学杂志,2005,23(6):603-605.
[32]韩江全,薛黔,杨方玖.人三角肌的肌内神经分布与亚部划分及其临床意义[J].中国临床解剖学杂志,2004,22(3):269-270,281.
[33]杨方玖,薛黔.人背阔肌肌内神经分布和肌构筑特征及其临床意义[J].中国临床解剖学杂志,2005,23(5):501-503,506.
[34]陈刚,江华,林子豪,等.尺侧腕伸肌内神经血管分布的应用解剖naris[J].中华显微外科杂志,2006,29(4):271-273,插275.
[35]Sanders I, Wu BL, Mu L, et al. The innervation of the human posterior cricoarytenoid muscle:evidence for at least two neuromuscular compartments[J]. Laryngoscope,1994, 104(7):880-884.
[36]杨胜波,薛黔,张永.家兔不同形态骨骼肌的肌内神经分布[J].解剖学报,2005,36(4):433-435.
1 Robbins T. Rectus abdominis myocutaneous flap for breast[J]. Reconstruction Aust NIJ Surg,1979, 49:527.
2 Yap L, Whiten S, Forster A, et al. The anatomical and neurophysiological basis of the sensate free TRAM and DIEP flaps[J]. Br J Plast Surg,2002,55:35-45.
3邬江,徐达传,钟世镇.多神经蒂的腹直肌瓣移植修复晚期面瘫的应用解剖[J].中国临床解剖学杂志,1996,14(4):252-254.
4廖贵清,苏宇雄,张金明,等.腹直肌-腹膜瓣修复舌缺损的临床研究[J].中华口腔医学杂志,2005,40(6):448-450.
5高崇敬.用腹直肌肌皮瓣再造乳房的应用解剖学[J].临床解剖学杂志,1986,4(1):25.
6刘立刚,Richard PR.94例腹直肌肌皮瓣肌皮动脉穿支的研究[J].中国修复重建外科杂志,2000,14(4):213-216.
7 Liu J, Kumar VP, Shen Y, et al. Modified Sihler's technique for studying the distribution of intramuscular nerve branches in mammalian skeletal muscle[J]. Anat Rec,1997,247(1):137-144.
8 Isenberg J. Sense and sensibility:breast reconstruction with innervated TRAM flaps[J]. Reconstr Micro surg,2002,18:23-28.
[2]王炜,主编.整形外科学[M].杭州：浙江科学技术出版社,1999:225-340,806-821.
[3]郭恩覃,主编.现代整形外科学[M].北京：人民军医出版社,2000:65-69,188-238.
[4]江华,郭恩覃,季正伦,等.吻合血管神经游离展肌移植一期修复晚期面瘫[J].中华外科杂志,1992,30(7))：420-423.
[5]LETBETTER, William D. Influence of intramuscular nerve branching on motor unit organization in medial gastroenemius muscle[J]. Anat Rec,1974,178:402.
[6]Serlin DM, Schieber MH. Morphologic regions of the multitendoned extrinsic finger muscles in the monkey forearm[J]. Acta Anat (Basel),1993,146(4):255-266.
[7]Homma T, Sakai T. Thenar and hypothenar muscles and their innervation by the ulnar and median nerves in the human hand[J]. Acta Anat (Basel),1992, 145(1):44-49.
[8]Ying R, Zhang M, Han Y, et al. Computer 3-dimensional reconstruction of intraglandular lymph vessels and ductal systems of the human submandibular gland[J]. Acta Anat,1992,144(2):175-177.
[9]Sihler C. Uber Muskelspindeln und intramuskulare Nervenendigungen bei Schlangen und Froschen[J]. Arch Mikros Anat Entwickl,1895,46:709-723.
[10]Warton LR. A technique for studying the innervation of organs[J]. Anat Rec,1937, 67:469-475.
[11]Williams TW. A technique for the gross differential staining of peripheral nerves in cleared vertebrate tissue[J]. Anat Rec,1943,86:189-194.
[12]Freihofer WC. The Sihler technique of staining nerves for systematic study especially of fishes[J]. Copeia,1966,3:470-475.
[13]Wu BL, Sanders I. A technique for demonstrating the nerve supply of whole larynges[J]. Arch Otolaryngol Head Neck Surg,1992,118(8):822-827.
[14]Drake W,3rd, Li Y, Rothschild MA, et al. A technique for displaying the entire nerve branching pattern of a whole muscle:results in 10 canine posterior cricoarytenoid muscles[J]. Laryngoscope,1993,103(2):141-148.
[15]Liu J, Kumar VP, Shen Y, et al. Modified Sihler's technique for studying the distribution of intramuscular nerve branches in mammalian skeletal muscle[J]. Anat Rec,1997,247(1):137-144.
[16]于大志,江华,党瑞山,等.腹直肌肌皮瓣的应用解剖及其肌内神经分布[J].解剖学杂志,2007,30(6):777-779.
[17]Hua J, Kumar VP, Pereira BP, et al. Split flexor carpi radialis muscle[J]. Plast Reconstr Surg,1999,103(3):930-934.
[18]于大志,江华,党瑞山,等.临床常用肌瓣肌内神经分布的研究[J].中国临床解剖学杂志,2008,26(6):595-597.
[19]Chen G, Jiang H, Liu AT, et al. Neurovascular details about forearm muscles: applications in their clinical use in functional muscular transfer[J]. Surg Radiol Anat,2009,32(1):3-8.
[20]Haschek E, Linderthal OT. Ein Beitrag zur praktischen Verwerthung der Photographie nach Rontgen[J]. Wien Klin Wochenschr,1896,9:63.
[21]Gough JA. A method of injecting the blood-vessels for roentgenological studies and simultaneously embalming[J]. Anat Rec,1920,18(193).
[22]Salmon M. Arte'res des muscles de la te^te et du cou[J]. Paris:Masson,1936.
[23]Tan BK, Ng RTH, Tay NS. Tissue microangiography using a simplified barium sulphate cadaver injection technique[J]. Ann Acad Med Singapore,1999,28:152.
[24]Taylor GI, Gianoutsos MP, Morris SF. The neurovascular territories of the skin and muscles:anatomic study and clinical implications[J]. Plast Reconstr Surg,1994, 94(1):1-36.
[25]Yang D, Morris SF. Neurovascular anatomy of the rectus femoris muscle related to functioning muscle transfer[J]. Plast Reconstr Surg,1999,104(1):102-106.
[26]Sihler C. Ueber Muskelspindeln und intramuskulare nervenendigungen bei schlangen und froschen.[J]. Arch Mikros Anat Entwickl,1895,46:709-723.
[27]Liem RS, Douwe van Willigen J. In toto staining and preservation of peripheral nervous tissue[J]. Stain Technology,1988,63(2):113-120.
[28]Wu BL, Sanders I. A technique for demonstrating the nerve supply of whole larynges[J]. Arch Otolaryngol Head Neck Surg,1992,118(8):822-827.
[29]Gupta R, Nelson SD, Baker J, et al. The innervation of the triangular fibrocartilage complex:nitric acid maceration rediscovered[J]. Plast Reconstr Surg,2001, 107(1):135-139.
[30]李平,薛黔,等.Sihler肌内神经染色方法的探讨[J].遵义医学院学报,2001,24(4)：317-319.
[31]王启明,薛黔,杨胜波.Sihler's肌内神经染色法的再改良[J].遵义医学院学报,2003,26(4)：322-324.
[32]薛黔,李名扬.人腓肠肌外侧头亚部化的研究[J].遵义医学院报,1985,8(4):5-8.
[33]韩江全,薛黔,杨方玖,人三角肌的肌内神经分布与亚部划分及其临床意义[J].中国临床解剖学杂志,2004,22(3):269-270,281.
[34]陈刚,江华,林子豪,等.前臂伸肌内神经血管分布的解剖学研究及其临床意义[J].中国临床解剖学杂志,2006,24(6):595-599.
[35]张跃蓉,刘静.人翼外肌肌内神经肌梭的分布及其意义[J].中国临床解剖学杂志,2007,25(5)：525-527.
[36]吴聪,薛黔,杨方玖.人膈肌内神经分支分布[J].中国临床解剖学杂志,2005,23(4)：378-380.
[37]Yousif NJ, Matloub HS, Kolachalam R, et al. The transverse gracilis musculocutaneous flap[J]. Ann Plast Surg,1992,29(6):482-490.
[38]Hallock GG. Further experience with the medial circumflex femoral(GRACILIS) perforator free flap[J]. J Reconstr Microsurg,2004,20(2):115-122.
[39]Vranckx JJ, Misselyn D, Fabre G, et al. The gracilis free muscle flap is more than just a "graceful" flap for lower-leg reconstruction[J]. J Reconstr Microsurg,2004, 20(2):143-148.
[40]Kumar PA. Cross-face reanimation of the paralysed face, with a single stage microneurovascular gracilis transfer without nerve graft:a preliminary report[J]. Br J Plast Surg,1995,48(2):83-88.
[41]Wellisz T, Rechnic M, Dougherty W, et al. Coverage of bilateral lower extremity calcaneal fractures with osteomyelitis using a single split free gracilis muscle transfer[J]. Plast Reconstr Surg,1990,85(3):457-460.
[42]Kumar VP, Liu J, Lau HK, et al. Neurovascular supply of the gracilis muscle:a study in the monkey and human[J]. Plast Reconstr Surg,1998,101(7):1854-1860.
[43]Taylor GI, Cichowitz A, Ang SG, et al. Comparative anatomical study of the gracilis and coracobrachialis muscles:implications for facial reanimation[J]. Plast Reconstr Surg,2003,112(1):20-30.
[44]Schoeller T, Meirer R, Gurunluoglu R, et al. Gracilis muscle split into two free flaps[J]. J Reconstr Microsurg,2003,19(5):295-298.
[45]Elbarrany WG, Al-Hayani A, Softa S. The blood and nerve supply of the long head of the biceps femoris muscle; its possible use in dynamic neoanal sphincter[J]. West Afr J Med,2005,24(4):287-294.
[46]Cavadas PC, Sanz-Jimenez-Rico JR, Landin L, et al. Biceps femoris perforator free flap for upper extremity reconstruction:anatomical study and clinical series[J]. Plast Reconstr Surg,2005,116(1):145-152.
[47]Tsetsonis CH, Laoulakos DH, Kaxira OS, et al. The biceps femoris short head muscle flap:an experimental anatomical study[J]. Scand J Plast Reconstr Surg Hand Surg,2003,37(2):65-68.
[48]Puschmann H, Rahmanzadeh R, Gorkisch K. [Restorative surgery on the lower leg using muscular shifting grafts-anatomical and clinical aspects (author's transl)][J]. Aktuelle Traumatol,1980,10(5):281-285.
[49]Hersh CK, Schenck RC, Williams RP. The versatility of the gastrocnemius muscle flap[J]. Am J Orthop (Belle Mead NJ),1995,24(3):218-222.
[50]Tsai CC, Lin TM, Lai CS, et al. Nonendoscopic harvest of the gastrocnemius muscle flap through a small incision[J]. Ann Plast Surg,2001,47(2):134-137.
[51]Seify H, Jones G, Sigurdson L, et al. Endoscopic harvest of four muscle flaps:safe and effective techniques[J]. Ann Plast Surg,2002,48(2):173-179.
[52]Jastrzebski J, Huber P. [Reconstruction in Achilles tendon rupture and simultaneous covering of a skin and soft tissue defect using the myocutaneous gastrocnemius sliding flap][J]. Handchir Mikrochir Plast Chir,1987, 19(5):281-283.
[53]Russell RC, Pribaz J, Zook EG, et al. Functional evaluation of latissimus dorsi donor site[J]. Plast Reconstr Surg,1986,78(3):336-344.
[54]Fraulin FO, Louie G, Zorrilla L, et al. Functional evaluation of the shoulder following latissimus dorsi muscle transfer[J]. Ann Plast Surg,1995,35(4):349-355.
[55]De Azevedo JF. Pectoralis minor flaps:an experimental study and clinical applications of osteomuscular, osteomyocutaneous, and myocutaneous models[J]. Head Neck Surg,1987,9(4):211-222.
1. Bardoel JW, Stadelmann WK, Perez-Abadia GA, Galandiuk S, Zonnevijlle ED, Maldonado C, Stremel RW, Tobin GR, Kon M, Barker JH (2001) Dynamic rectus abdominis muscle sphincter for stoma continence:an acute functional study in a dog model. Plast Reconstr Surg 107:478-484
2. Boyle KE, Moran ME, Calvano CJ, White MD, Reddy PP, Mehlhaff BA (1998) Endoscopic subcutaneous neurovascular lower-extremity myofascial flap harvesting for genitourinary reconstruction. J Endourol 12:187-191
3. Chambers JN, Purinton PT, Moore JL, Allen SW (1990) Treatment of trochanteric ulcers with cranial sartorius and rectus femoris muscle flaps. Vet Surg 19:424-428
4. Clavert P, Cognet JM, Baley S, Stussi D, Prevost P, Babin SR, Simon P, Kahn JL (2008) Anatomical basis for distal sartorius muscle flap for reconstructive surgery below the knee. Anatomical study and case report. J Plast Reconstr Aesthet Surg 61:50-54
5. De Azevedo JF (1987) Pectoralis minor flaps:an experimental study and clinical applications of osteomuscular, osteomyocutaneous, and myocutaneous models. Head Neck Surg 9:211-222
6. Fattah A, Figus A, Mathur B, Ramakrishnan VV (2008) The transverse myocutaneous gracilis flap:technical refinements. J Plast Reconstr Aesthet Surg doi:10.1016/j.bjps.2008.10.015
7. Gravvanis A, Caulfield RH, Mathur B, Ramakrishnan V (2009) Management of inguinal lymphadenopathy:immediate sartorius transposition and reconstruction of recurrence with pedicled ALT flap. Ann Plast Surg 63:307-310
8. Giilekon N, Peker T, Turgut HB, Anil A, Karakose M (2007) Qualitative comparison of anatomical microdissection, Sihler's staining and computerized reconstruction methods for visualizing intramuscular nerve branches. Surg Radiol Anat 29:373-378
9. Harrison DH (2002) The treatment of unilateral and bilateral facial palsy using free muscle transfers. Clin Plast Surg 29:539-549, vi
10. Jiang H, Guo ET, Ji ZL, Zhang ML, Lu V (1995) One-stage microneurovascular free abductor hallucis muscle transplantation for reanimation of facial paralysis. Plast Reconstr Surg 96:78-85
11. Kay S, Pinder R, Wiper J, Hart A, Jones F, Yates A (2009) Microvascular free functioning gracilis transfer with nerve transfer to establish elbow flexion. J Plast Reconstr Aesthet Surg doi:10.1016/j.bjps.2009.05.021
12. Lee JW, Lee YC, Chang TW (2008) Microvascularly augmented transverse rectus abdominis myocutaneous flap for breast reconstruction--reappraisal of its value through clinical outcome assessment and intraoperative blood gas analysis. Microsurg 28:656-662
13. Letbetter, William D (1974) Influence of intramuscular nerve branching on motor unit organization in medial gastroenemius muscle. Anat Rec 178:402
14. Liem RS, Douwe van Willigen J (1988) In toto staining and preservation of peripheral nervous tissue. Stain Technol 63:113-120
15.Lim AY, Pereira BP, Kumar VP, De Coninck C, Taki C, Baudet J, Merle M (2004) Intramuscular innervation of upper-limb skeletal muscles. Muscle Nerve 29:523-530
16. Liu J, Kumar VP, Shen Y, Lau HK, Pereira BP, Pho RW (1997) Modified Sihler's technique for studying the distribution of intramuscular nerve branches in mammalian skeletal muscle. Anat Rec 247:137-144
17.Michlits W, Gruber S, Windhofer C, Macheiner P, Walsh M, Papp C (2008) Reconstruction of soft tissue defects overlying the Achilles tendon using the super extended abductor hallucis muscle flap. J Trauma 65:1459-1462
18. Moinfar AR, Murthi AM (2007) Anatomy of the pectoralis minor tendon and its use in acromioclavicular joint reconstruction. J Shoulder Elbow Surg 16:339-346
19. Ortak T, Uraloglu M, Orbay H, Tekin F, Unlu RE, Sensoz O (2006) Transfer of innervated split latissimus dorsi free musculocutaneous flap for flexion and extension of the fingers. Ann Plast Surg 56:443-446
20. Peker T, Gulekon N, Turgut BH, Anil A, Karakose M, Mungan T, Danisman N (2006) Observation of the relationship between the shape of skeletal muscles and their nerve distribution patterns:a transparent and microanatomic study. Plast Reconstr Surg 117:165-176
21. Sihler C (1895) Ueber Muskelspindeln und intramuskulare nervenendigungen bei schlangen und froschen. Arch Mikros Anat Entwickl 46:709-723
22. Takeishi M, Fujimoto M, Ishida K, Makino Y (2008) Muscle sparing-2 transverse rectus abdominis musculocutaneous flap for breast reconstruction:a comparison with deep inferior epigastric perforator flap. Microsurg 28:650-655
23. Terzi A, Luzzi L, Campione A, Gorla A, Calabro F (2009) The split latissimus dorsi muscle flap to protect a bronchial stump at risk of bronchial insufficiency. Ann Thorac Surg 87:329-330
24. Werker PM (2007) [Plastic surgery in patients with facial palsy]. Ned Tijdschr Geneeskd 151:287-294
25. Wong C, Saint-Cyr M (2009) The pedicled descending branch muscle-sparing latissimus dorsi flap for trunk and upper extremity reconstruction. J Plast Reconstr Aesthet Surg doi:10.1016/j.bjps.2009.01.059
26. Wu BL, Sanders I (1992) A technique for demonstrating the nerve supply of whole larynges. Arch Otolaryngol Head Neck Surg 118:822-827
27. Yercan HS, Ozalp T, Okcu G (2007) Reconstruction of diabetic foot ulcers by lateral supramalleolar flap. Saudi Med J 28:872-876
28.Ying R, Zhang M, Han Y, Wang G, Chen K, Cai Y (1992) Computer 3-dimensional reconstruction of intraglandular lymph vessels and ductal systems of the human submandibular gland. Acta Anat 144:175-177
[1]Hua J, En-tan G, Zheng-lun J, et al. One-stage microneurovascular free abductor hallucis muscle transplantation for the reanimation of facial paralysis[J]. Plast Reconstr Surg,1995,96(1):178-184.
[2]钟世镇.临床应用解剖学.北京：人民军医出版社,1998:797-799.
[3]Homma T, Sakai T. Thenar and hypothenar muscles and their innervation by the ulnar and median nerves in the human hand[J]. Acta Anat,1992,145:44-49.
[4]Serlin DM, Schieber MH. Morphologic regions of the multitendoned extrinsic finger muscles in the monkey forearm[J]. Acta Anat (Basel),1993,146(4):255-266.
[5]Wu BL, Sanders I. A technique for demonstrating the nerve supply of whole larynges[J]. Arch Otolaryngol Head Neck Surg,1992,118(8):822-827.
[6]Drake W,3rd, Li Y, Rothschild MA, et al. A technique for displaying the entire nerve branching pattern of a whole muscle:results in 10 canine posterior cricoarytenoid muscles[J]. Laryngoscope,1993,103(2):141-148.
[7]Sihler C. Ueber Muskelspindeln und intramuskulare nervenendigungen bei schlangen und froschen.[J]. Arch Mikros Anat Entwickl,1895,46:709-723.
[8]Liem RS, Douwe van Willigen J. In toto staining and preservation of peripheral nervous tissue[J], Stain Technol,1988,63(2):113-120.
[9]Liu J, Kumar VP, Shen Y, et al. Modified Sihler's technique for studying the distribution of intramuscular nerve branches in mammalian skeletal muscle[J]. Anat Rec,1997,247(1):137-144.
[10]Gupta R, Nelson SD, Baker J, et al. The innervation of the triangular fibrocartilage complex:nitric acid maceration rediscovered[J]. Plast Reconstr Surg,2001, 107(1):135-139.
[11]李平,薛黔,等.Sihler肌内神经染色方法的探讨[J].遵义医学院学报,2001,24(4):317-319.
[12]王启明,薛黔,杨胜波.Sihler's肌内神经染色法的再改良[J].遵义医学院学报,2003,26(4)：322-324.
[13]杜卓民.实用组织学技术(第二版).北京：人民卫生出版社,1998:36-37.
[14]李文,张赛霞.常用苏木素几种配方与染色结果的比较[J].解剖学杂志,2000,23(4):393-394.
[15]Sanders I, Mu L. Anatomy of the human internal superior laryngeal nerve[J]. Anat Rec, 1998,252(4):646-656.
[16]Zur KB, Mu L, Sanders I. Distribution pattern of the human lingual nerve[J]. Clin Anat, 2004,17(2):88-92.
[17]张跃蓉,刘静.人咬肌肌内神经的分布及临床意义[J].遵义医学院学报,2004,27(2)：106-108.
[18]Lim AY, Pereira BP, Kumar VP, et al. Intramuscular innervation of upper-limb skeletal muscles[J]. Muscle Nerve,2004,29(4):523-530.
[19]Gozil R, Kadioglu D, Calguner E, et al. Branching patterns of rabbit oculomotor and trochlear nerves demonstrated by Sihler's stain technique[J]. Biotech Histochem,2002, 77(1):21-25.
[20]吴聪,薛黔,杨方玖.人膈肌内神经分支分布[J].中国临床解剖学杂志,2005,23(4):378-380.
[21]张洪武,薛黔,杨方玖.人股直肌肌内神经分布和神经入肌点定位研究in human rectus femoris[J].遵义医学院学报,2006,29(2):111-113.
[22]Letbetter W. Influence of intramuscular nerve branching on motor unit organization in medial gastroenemius muscle[J]. Anat Rec,1974:178-202.
[23]English A, Letbetter W. Anatomy and innervation patterns of cat lateral gastrocnemius and plantaris muscles[J]. Am J Anat,1982,164:67-77.
[24]Kumar VP, Liu J, Lau HK, et al. Neurovascular supply of the gracilis muscle:a study in the monkey and human[J]. Plast Reconstr Surg,1998,101(7):1854-1860.
[25]Taylor G, Gianoutsos M, Morris S. The neurovascular territories of the skin and muscles:anatomic study and clinical implications[J]. Plast Reconstr Surg,1994, 94:1-36.
[26]Hua J, Kumar VP, Pereira BP, et al. Split flexor carpi radialis muscle[J]. Plast Reconstr Surg,1999,103(3):930-934.
[27]Lim AY, Kumar VP, Hua J, et al. The neuromuscular compartments of the flexor carpi ulnaris[J]. Plast Reconstr Surg,1999,103(3):1046-1051; quiz 1052, discussion 1053.
[28]陈刚,江华,林子豪,等.家兔小腿三头肌内神经和血管分布的研究[J].第二军医 大学学报,2005,26(1):38-40.
[29]Kierner AC, Zelenka I, Burian M. How do the cervical plexus and the spinal accessory nerve contribute to the innervation of the trapezius muscle? As seen from within using Sihler's stain[J]. Arch Otolaryngol Head Neck Surg,2001,127(10):1230-1232.
[30]Godat DM, Sanger JR, SD L. Detailed neurovascular anatomy of the serratus anterior muscle:implications for a functional muscle flap with multiple independent force vectors[J]. Plast Reconstr Surg,2004,114(1):21-31.
[31]陈刚,江华,林子豪,等.掌长肌内神经血管的解剖学观察及其临床意义[J].中国临床解剖学杂志,2005,23(6):603-605.
[32]韩江全,薛黔,杨方玖.人三角肌的肌内神经分布与亚部划分及其临床意义[J].中国临床解剖学杂志,2004,22(3):269-270,281.
[33]杨方玖,薛黔.人背阔肌肌内神经分布和肌构筑特征及其临床意义[J].中国临床解剖学杂志,2005,23(5):501-503,506.
[34]陈刚,江华,林子豪,等.尺侧腕伸肌内神经血管分布的应用解剖naris[J].中华显微外科杂志,2006,29(4):271-273,插275.
[35]Sanders I, Wu BL, Mu L, et al. The innervation of the human posterior cricoarytenoid muscle:evidence for at least two neuromuscular compartments[J]. Laryngoscope,1994, 104(7):880-884.
[36]杨胜波,薛黔,张永.家兔不同形态骨骼肌的肌内神经分布[J].解剖学报,2005,36(4):433-435.
1 Robbins T. Rectus abdominis myocutaneous flap for breast[J]. Reconstruction Aust NIJ Surg,1979, 49:527.
2 Yap L, Whiten S, Forster A, et al. The anatomical and neurophysiological basis of the sensate free TRAM and DIEP flaps[J]. Br J Plast Surg,2002,55:35-45.
3邬江,徐达传,钟世镇.多神经蒂的腹直肌瓣移植修复晚期面瘫的应用解剖[J].中国临床解剖学杂志,1996,14(4):252-254.
4廖贵清,苏宇雄,张金明,等.腹直肌-腹膜瓣修复舌缺损的临床研究[J].中华口腔医学杂志,2005,40(6):448-450.
5高崇敬.用腹直肌肌皮瓣再造乳房的应用解剖学[J].临床解剖学杂志,1986,4(1):25.
6刘立刚,Richard PR.94例腹直肌肌皮瓣肌皮动脉穿支的研究[J].中国修复重建外科杂志,2000,14(4):213-216.
7 Liu J, Kumar VP, Shen Y, et al. Modified Sihler's technique for studying the distribution of intramuscular nerve branches in mammalian skeletal muscle[J]. Anat Rec,1997,247(1):137-144.
8 Isenberg J. Sense and sensibility:breast reconstruction with innervated TRAM flaps[J]. Reconstr Micro surg,2002,18:23-28.