皮瓣静脉构筑的解剖学研究及其临床意义
|
摘要
目的 本课题的研究目的包括以下6项内容：(1)对皮瓣的动、静脉系统，特别是静脉系统进行解剖学研究，探索皮瓣内轴心动、静脉走行及分支分布规律；(2)阐明皮瓣内深、浅静脉系或伴行静脉与非伴行静脉的起始、走行、引流范围及交通途径；(3)观测皮瓣深、浅静脉干及其交通支内静脉瓣部位、形态、功能及对静脉间血液流通的影响；(4)明确皮瓣的动、静脉伴行特点与静脉回流规律；(5)确定皮瓣静脉回流的主渠道；(6)为皮瓣游离移植吻合静脉的选择，提供解剖学依据，并对跨区供血皮瓣静脉回流与交通、非生理性皮瓣的血液循环进行探索。通过上述研究，进一步阐明皮瓣静脉的立体构筑，探求其机理，并完善解剖学资料，以期为皮瓣的应用指征、吻合静脉的选择及危象的处置等，提供解剖学基础，更好地指导临床皮瓣外科。方法 (1)采用新鲜成人尸体双下肢标本，于股动脉及足背静脉网顺、逆行插管，分别注入8％明胶碳素墨汁，尔后行股动脉灌注及局部注射福尔马林防腐。切取皮瓣流水冲洗，酒精梯度脱水，二甲苯透明，冬青油内保存。(2)采用新鲜成人尸体上、下肢标本，于股动脉灌注红色乳胶，足背静脉网顺、逆行及股静脉加压灌注蓝色乳胶，福尔马林溶液防腐。新鲜男性成人尸体1具，于双侧股动脉插管内分别先后行8％明胶碳素墨汁→14％氨水→红色乳胶溶液灌注，至趾腹颜色由黑变红为止，流水冲洗6小时。另取新鲜成人尸体之肩胛皮瓣，股前外侧皮瓣，胸脐皮瓣及膝上内侧皮瓣，冲洗、防腐处理后，再于动脉灌注8％明胶墨汁溶液。(3)采用1例新鲜尸体左下肢标本制备过氯乙烯动(红)、静(蓝)脉分色铸型标本。(4)右下肢冷藏标本，于股动脉灌注红色乳胶，再于股静脉及大隐静脉顺、逆行灌注含硫酸钡混悬液之蓝色乳胶，福尔马林防腐，然后切取皮瓣，摄取x线片。(5)右下肢新鲜标本，制备组织切片。将标本冲洗、固定后，于动脉插管内灌注8％明胶墨汁，至浅表皮肤均匀变黑并可见静脉内有灌注液溢出即行停止。放置3天后，取4块右股前外侧皮瓣、4块小腿内侧皮
瓣之墨染明显区域，经酒精梯度脱水、二甲苯及冬青油先后透明、石蛤
包埋，连续水平及垂直切片，其厚度分别为 15、20及 100 u m，fiE染色，
组织显微镜下观测。结果 门）亘接皮动脉或肌皮动脉，在体被组织逐
步浅出的整个行程中，不断发出分支并分别在深筋膜层、皮下组织（浅
筋膜）层、真皮下层、乳头下层和乳头层内形成五级具有鉴别特征的皮
肤微循环血管网（血管树）。（2）体被组织静脉血管网由浅入深分为五层：
皮肤乳头层。乳头下层、真皮下层、皮下组织层和深筋膜层。山乳头下
层浅出的小动脉分支及末支，在真皮乳头层内形成毛细血管网，迂曲盘
旋并返折形成微血管拌，延续、下降、吻合形成毛细血管后微静脉。毛
细血管后微静脉相互吻合、汇合形成集合微静脉并伴行动脉进入乳头下
层，组成乳头下层微静脉网。乳头下层微静脉和集合微静脉经2～4级汇
合后，即向深面走行汇入真皮下层微静脉网或丛。多数真皮下层微静脉。
小静脉伴行动脉进入皮下组织层、深筋膜层，并与皮下组织层和深筋膜
层动脉分支的伴行静脉汇合，分别形成皮下组织层、深筋膜层静脉网，
进而汇入轴心动脉的伴行静脉。而真皮下血管网中与动脉不伴行的微静
脉汇合成为小静脉，并逐渐聚集增粗，汇合加入浅非伴行静脉属支或即
为属支的起点。结论 门）皮瓣静脉构筑可分为5层血管网，吻合交通
丰富；（2）皮瓣血管多为动、静脉伴行，皮瓣轴心动脉的伴行静脉是皮
瓣血液回流的主渠道，为游离移植时的首选吻合静脉，而浅非伴行静脉
的回流起辅助作用。（3）深、浅静脉间可经交通支、穿支吻合支而绕过
静脉瓣进行沟通。
Objectives:The purposes of the present study are as follows:(1) Anatomical study inclulding observation and measurement on arterial,especially venous system of flap was performed to attempt to illuminate the regular patterns of the distribution of the arteries,veins and their branches in the axial vascular skin flap. (2) Fathoming the origination,distribution,drainage scope and communicating path of deep and superficial veins or accompanied and unaccompanied veins. (3) Elucidating the positions,shape and functions of venous valves in deep and superficial venous stem and its communicating branches,observing their affects on the venous blood circulation. (4) Clarifying the accompanied characters of the veins and arteries of the flap and the reflux routes of vein. (5) Confirming the main channels of venous reflux of flap. (6) Providing anatomical evidence for the selection of vein engrafting in flap free grafting or transplantation. Study the vein reflux and communication of flap whose blood supply is trans-sec
tion and clarify the blood circulation of non-physical flap. Through all of the work mentioned above,elucidating the stereo architecture of flap vein and ensuring the mechanism inside,provide anatomical basis for the applying characteristic,selection of engraft vein and the treatment of the circulation crisis.Methods:(1) Using both lower limbs of fresh adult cadavers,cannulas inserted forward from femoral artery and backward from dorsal venous networks of foot to inject 8% gelatin carbonic ink,intra-femoral and local inject formalin to prevent rot. Gutted flap washed by current water,dehydrate using graded ethanol,vitrification by dimethylbenzene and deposited in holly oil. (2) Using both upper and lower limbs of a fresh adult cadaver,inject red gelatin into femoral,forward and backward injecting the blue gelatin with
high pressure into femoral vein with formalin preventing rot. As for fresh male adult cadaver,inject 8% gelatin carbonic ink,14% ammonia and red gelatin until the ventral skin of the toe turn red from black,washing 6 hours by flowing water. Cutting the scapular flap,anterolateral femoral flap,chest-umbilicus flap and medial superior genicular flap,after washing and rot prevention,inject 8% gelatin ink solution into artery. (3) Left lower limb was used to prepare artery(red) and vein(blue) color cast specimens using perchloroethylene.(4) Deep freezed right lower limb sample,injecting red gelatin into femoral artery,forward and backward injecting blue latex with barium sulfate into femoral vein and great saphenous vein,cuting flap after dealing with formalin and get x-ray photos. (5) Fresh right lower limb sample:making tissue into slice samples,after washing and fixation,injecting 8% gelatin ink into artery by cannulas until the superficial skin turn black equally and injection solution overflow from the vein. Get 4 right anterolateral femoral flaps and 4 left scapular flaps which were dyed obviously after 3 days,dehydrate by graded ethanol,vitrification and paraffin embeded,horizontally and vertically sliced continuously,thickness is 15,20 and lOOjtim respectively,HE dyed,observed under microscope.Results:(1) Direct cutaneous artery or musculo-cutaneous artery,in the procedure of common integument tissue being shallowed up step by step,continuously sending out branches to deep fascia layer,superficial fascia layer,hypodermis layer,hypopapilla layer and papilla layer to form the five-grade cutaneous microcirculation "blood vessel tree" of the skin blood vessel network that can be identified. (2) Common integument tissue venous vessel network can be divided into five layers from superficial layer to deep layer:cutaneous papillary layer,hypopapillary layer,hypodermis layer,subdermal layer and deep fascia layer.The artery branch and arteriole that shallowed up from hypopapillar layer get to papillar layer to form vessel network,circuitous and twisted,reflux and anastomose to become postcapillary micro veins and endothelial venule,then anastomose each other and accompanied with artery to ente
瓣之墨染明显区域，经酒精梯度脱水、二甲苯及冬青油先后透明、石蛤
包埋，连续水平及垂直切片，其厚度分别为 15、20及 100 u m，fiE染色，
组织显微镜下观测。结果 门）亘接皮动脉或肌皮动脉，在体被组织逐
步浅出的整个行程中，不断发出分支并分别在深筋膜层、皮下组织（浅
筋膜）层、真皮下层、乳头下层和乳头层内形成五级具有鉴别特征的皮
肤微循环血管网（血管树）。（2）体被组织静脉血管网由浅入深分为五层：
皮肤乳头层。乳头下层、真皮下层、皮下组织层和深筋膜层。山乳头下
层浅出的小动脉分支及末支，在真皮乳头层内形成毛细血管网，迂曲盘
旋并返折形成微血管拌，延续、下降、吻合形成毛细血管后微静脉。毛
细血管后微静脉相互吻合、汇合形成集合微静脉并伴行动脉进入乳头下
层，组成乳头下层微静脉网。乳头下层微静脉和集合微静脉经2～4级汇
合后，即向深面走行汇入真皮下层微静脉网或丛。多数真皮下层微静脉。
小静脉伴行动脉进入皮下组织层、深筋膜层，并与皮下组织层和深筋膜
层动脉分支的伴行静脉汇合，分别形成皮下组织层、深筋膜层静脉网，
进而汇入轴心动脉的伴行静脉。而真皮下血管网中与动脉不伴行的微静
脉汇合成为小静脉，并逐渐聚集增粗，汇合加入浅非伴行静脉属支或即
为属支的起点。结论 门）皮瓣静脉构筑可分为5层血管网，吻合交通
丰富；（2）皮瓣血管多为动、静脉伴行，皮瓣轴心动脉的伴行静脉是皮
瓣血液回流的主渠道，为游离移植时的首选吻合静脉，而浅非伴行静脉
的回流起辅助作用。（3）深、浅静脉间可经交通支、穿支吻合支而绕过
静脉瓣进行沟通。
Objectives:The purposes of the present study are as follows:(1) Anatomical study inclulding observation and measurement on arterial,especially venous system of flap was performed to attempt to illuminate the regular patterns of the distribution of the arteries,veins and their branches in the axial vascular skin flap. (2) Fathoming the origination,distribution,drainage scope and communicating path of deep and superficial veins or accompanied and unaccompanied veins. (3) Elucidating the positions,shape and functions of venous valves in deep and superficial venous stem and its communicating branches,observing their affects on the venous blood circulation. (4) Clarifying the accompanied characters of the veins and arteries of the flap and the reflux routes of vein. (5) Confirming the main channels of venous reflux of flap. (6) Providing anatomical evidence for the selection of vein engrafting in flap free grafting or transplantation. Study the vein reflux and communication of flap whose blood supply is trans-sec
tion and clarify the blood circulation of non-physical flap. Through all of the work mentioned above,elucidating the stereo architecture of flap vein and ensuring the mechanism inside,provide anatomical basis for the applying characteristic,selection of engraft vein and the treatment of the circulation crisis.Methods:(1) Using both lower limbs of fresh adult cadavers,cannulas inserted forward from femoral artery and backward from dorsal venous networks of foot to inject 8% gelatin carbonic ink,intra-femoral and local inject formalin to prevent rot. Gutted flap washed by current water,dehydrate using graded ethanol,vitrification by dimethylbenzene and deposited in holly oil. (2) Using both upper and lower limbs of a fresh adult cadaver,inject red gelatin into femoral,forward and backward injecting the blue gelatin with
high pressure into femoral vein with formalin preventing rot. As for fresh male adult cadaver,inject 8% gelatin carbonic ink,14% ammonia and red gelatin until the ventral skin of the toe turn red from black,washing 6 hours by flowing water. Cutting the scapular flap,anterolateral femoral flap,chest-umbilicus flap and medial superior genicular flap,after washing and rot prevention,inject 8% gelatin ink solution into artery. (3) Left lower limb was used to prepare artery(red) and vein(blue) color cast specimens using perchloroethylene.(4) Deep freezed right lower limb sample,injecting red gelatin into femoral artery,forward and backward injecting blue latex with barium sulfate into femoral vein and great saphenous vein,cuting flap after dealing with formalin and get x-ray photos. (5) Fresh right lower limb sample:making tissue into slice samples,after washing and fixation,injecting 8% gelatin ink into artery by cannulas until the superficial skin turn black equally and injection solution overflow from the vein. Get 4 right anterolateral femoral flaps and 4 left scapular flaps which were dyed obviously after 3 days,dehydrate by graded ethanol,vitrification and paraffin embeded,horizontally and vertically sliced continuously,thickness is 15,20 and lOOjtim respectively,HE dyed,observed under microscope.Results:(1) Direct cutaneous artery or musculo-cutaneous artery,in the procedure of common integument tissue being shallowed up step by step,continuously sending out branches to deep fascia layer,superficial fascia layer,hypodermis layer,hypopapilla layer and papilla layer to form the five-grade cutaneous microcirculation "blood vessel tree" of the skin blood vessel network that can be identified. (2) Common integument tissue venous vessel network can be divided into five layers from superficial layer to deep layer:cutaneous papillary layer,hypopapillary layer,hypodermis layer,subdermal layer and deep fascia layer.The artery branch and arteriole that shallowed up from hypopapillar layer get to papillar layer to form vessel network,circuitous and twisted,reflux and anastomose to become postcapillary micro veins and endothelial venule,then anastomose each other and accompanied with artery to ente
引文
1．钟世镇、徐达传．显微外科基础研究概况．中华显微外科杂志[J]，1997，20(3)：167～168
2．钟世镇．我国显微外科进展有关的解剖学研究．中华手外科杂志[J]，1996，12(1)：1～3
3．钟世镇．组织瓣移植研究近况．中华手外科杂志[J]，1998，14(4)：193～195
4．朱家恺，庞水发．把我国显微外科推向21世纪新里程．中华显微外科杂志[J]，2000，20(1)：5～7
5.Harii K.Ohmori, K, Ohmori,S.Hair transplantation with free scalp flap. Plast Reconstr Sing, 1974,53(4):410～413
6.Daniel RK, Williams HB. The free transfer of skin flaps by microvascular anastomoses. Plast Reconstr Surg, 1973, 52(1):16～31
7．上海第一医学院华山医院口腔外科、手外科．带血管的游离皮瓣移植修复颊部缺损一例报告．中华医学杂志[J]，54：163
8．王成琪，王剑利，张敬良，等．皮瓣移植术的回顾与展望．中华显微外科杂志[J]，2000，23(1)：12～15
9．顾玉东．皮瓣进展20年(1973～1993)．中华外科杂志[J]，1994，10(2)：67～68
10．王渭滨，柳大烈，孟庆延，等．跨区互蒂轴型皮瓣的研究进展．中国临床解剖学杂志[J]，2000；18(4)：385～388
11．钟世镇．显微外科基础研究的回顾与展望．中华显微外科杂志[J]，2000，23(1)：8～9
12．钟世镇 主编．显微外科解剖学．北京：人民卫生出版社，1984
13.Taylor GI, Palmer JH. The vascular territories (angiosomes)of the body:experimental study and clinical applications. Brit J Plast Surg, 1987,40(2): 113～141
14.Taylor GI,Minabe T. The angiosomes of the mammals and other vertebrates.Plast Reconstr Surg, 1994,94(1): 1～37
15．顾玉东．皮瓣的静脉危象及其处理．中华手外科杂志[J]，1996，12(3)：131～133
16．钟世镇，孙博．皮瓣静脉回流解剖学研究概况．中华显微外科杂志[J]，1986，9(1)：47～49
17.Taylor GI, Caddy CM, Watterson PA, et al.The venous territories (venosomes)of the human body:experimental study and clinical implications. Plast Reconstr Surg, 1990,86(1):185～213
18．李忠华，王兴海主编．解剖学技术．北京：人民卫生出版社，1997
19．龚志锦，詹镕洲编著．病理组织制片和染色技术．上海：上海科学技术出版社，1994
20．钟世镇，徐达传．肢体血供规律与组织瓣设计的关系．中国临床解剖学杂志[J]，1996，14(3)：161～164
21．钟世镇，徐达传，刘牧之，等．缘支对阔筋膜张肌皮瓣的临床意义．临床应用解剖学杂志[J]．1984，2(3)：153～155
22.Haertsch PA. The surgical plane in the leg. Brit J Plast Surg, 1981,34(5):464～469
23．毛增荣，施恩娟，张成立，等．皮瓣的血管构筑．解剖学通报[J]，1984，7(2)：138～142
24．郭光金，陈尔瑜，陈维佩，等．腹部皮瓣的动脉及血管网构筑．解剖学报[J]，1992，23(2)：113～117
25．杨果凡，陈宝驹，高玉智，等．前臂皮瓣游离移植术．中华医学杂志[J]，1981，61(3)：139～141
26．钟世镇，徐达传．组织瓣的解剖学基础与命名的关系．中华手外科杂志[J]，1998，14(4)：194～196
27.Fujino T. Contribution of the axial and perforator vasculature to circulation in flaps.Plast Reconstr Surg, 1967,39(1): 125～137
28.Smith PJ. The importance of venous drainage in axial pattern falaps. Br J Plast Surg,1978(2),31:233～237
29.Su CT, Im MJ,Hoopers JE,et al. Tissue glucose and lactate following vascular occlusion in island skin flaps. Plast Reconstr Surg, 1982,70(2):202～205
30．福居显宏，玉井进，增原建二，他．有茎皮瓣延长静脉还流路意义．形成外科，1983；26(2)：164～173
31.Taylor GI,Pan WR.Angiosomes of the leg, anatomic study and clinical implications.Plast Reconstr Surg, 1998,102(3):599～616
32．钟世镇．组织瓣手术血供有关的解剖学要点．中国现代手术学杂志[J]，2001，5(2)：83～86
33.Timmons MJ.Landmarks in the anatomical study of the blood supply of the skin. Brit Plast Surg, 1985,38(2): 197～207
34．刘芬兰，张富安，关阑，等．腹部皮瓣的微血管构筑．局解手术学杂志[J]，1994，3(3)：5～10
35．柏树令，李吉．小腿后部皮瓣的微细血管构筑．解剖学通报[J]，1983，6(4)：334～339
36．李吉，刘志，李桂珍，等．大腿前部皮瓣微血管构筑．中国医科大学学报[J]，1989，18(1)：18～21
37．乔连铭，高振平，孙天恩，等．背阔肌皮瓣的微血管构筑．中国临床解剖学杂志[J]，1997，15(4)：276～279
38．高建华，罗锦辉．真皮下血管网皮瓣移植．中华整形烧伤外科杂志39．高建华，罗锦辉，百束比占，等．窄蒂并远端吻合血管的巨大枕颈背真皮下血管网薄皮瓣．中华整形烧伤外科杂志[J]，1997，13(2)：115～116
39．徐达传，钟世镇，刘牧之，等．股前外侧部皮瓣的解剖学．临床应用解剖学杂志[J]，1984，2(3)：158～160
40．肖添有，司徒朴，陈伯华，等．轴型血管蒂股前外侧真皮下血管网皮瓣的应用解剖．中国临床解剖学杂志[J]，1997，15(1)：7～9
41．肖添有，肖能坎，司徒朴，等．轴型真皮下血管网皮瓣的应用解剖．解剖学研究[J]，2001，23(1)：11～13
42．陈伯华，徐达传，司徒朴，等．颈肩肱部真皮下血管网皮瓣的解剖学基础．中国临床解剖学杂志[J]，1993，11(4)：245～248
43．李谆，原林，高岚，等．颈胸前筋膜皮瓣修复颈前瘢痕的解剖学研究．中国美容医学杂志[J]，2000，9(6)：331～333
44．宋业光，修志夫，张智勇，等．真皮下血管网薄皮瓣血管构筑变化与成纤维细胞生长因子的关系．中华整形烧伤外科杂志[J]，1996，12(5)：323～325
45．徐达传，钟世镇，何尚宽，等．筋膜骨膜骨瓣移位术的解剖学基础．中国临床解剖学杂志[J]，1990，8(4)：207～210
46．侯春林，张世民 编著．筋膜皮瓣与筋膜蒂组织瓣．上海：上海科学技术出版社，2001
47.Robotti E,Verna G, Fraccalvieri M,et al. Distally based fasciocutaneous flaps:a versatile option for coverage of difficult war wounds of the foot and ankle. Plast Reconstr Surg,,1998,101(4):1014～1021
48.Lamberty BGH, Cormack GC.Fasciocutaneous flaps. Clin Plast Surg,1990,17(6):713～726
49．马显杰，鲁开化，艾玉峰，等．跨区供血的轴型皮的成活机理的实验研究．解放军医学杂志[J]，1993，18(2)：91～93
50．王臻，鲁开化．跨区供血皮瓣与预构皮瓣血管化研究进展．中华显微外科杂志[J]，1997，20(3)：172～175
51.Cormack GC. Lamberty BGH.The blood supply of thigh skin.Plast 1985,75(3):342～354
52.Comack GC, Lamberty BGH. Cadaver study of correlation between vessel size and anatomical territory of cutaneous supply. Brit J Plast Surg, 1986,39(3):300～306
53．周礼荣，丁任，蔡仁祥，等．四肢皮神经营养血管皮瓣的临床应用．中华显微外科杂志[J]，2000，23(1)：26～28
54．侯之启，钟世镇，孙博．小腿皮瓣的静脉瓣研究．中华显微外科杂志[J]，1987；10(1)：29～30
55.Erdmann MW, Court-Brown CM, Quaba AA. A five year review of island distally based fasciocutaneous flaps on the lower limb. Brit J Plast Surg, 1997,50(6):421～427
56．鲁开化，钟德才，陈璧，等．前臂桡动脉逆行皮瓣及其临床应用．中华外科杂志[J]，1982，20(11)：695～697
57．孙博，刘牧之，原林，等．前臂桡侧岛状逆行旋转皮瓣静脉回流的解剖学研究．临床应用解剖学杂志[J]，1983，1(1)：8～12
58．孙博，钟世镇，郑玉明，等．前臂、小腿逆行皮瓣静脉回流的实验研究．显微医学杂志[J]，1985；8(3)：148～150
59．郑玉明，李运连，陈庄洪，等．前臂岛状皮瓣移位术在手外科的应用．解放军医学杂志，1983，8(3)：168～171
60．关桂春．小腿内侧岛状皮瓣逆行移位术解剖学所见．临床应用解剖学杂志[J]，1985，3(1)：9～10
61.Imanishi N, Nakajima H, Fukuzumi S, et al. Venous drainage of the distally based lesser spahenous-sural veno-neuroadipofascial pedicled fasiocutaneous flap: a radiographic perfusion study. Plast Reconstr Surg, 1999, 103(2):494～498
62.Budo, J, Finucan T, Clarke J. The inner arm fasciocutaneous flap. Plast Reconstr Surg, 1984,73(4):629～632
63．张世民，侯春林，徐瑞生，等．浅静脉干对四肢远端蒂皮瓣作用的实验研究．中国临床解剖学杂志[J],2001，19(2)：175～176
64．张世民，陈中伟．前臂远端蒂筋膜皮瓣的静脉回流．手外科杂志[J]，1992，8(2)：72～73
65．康安，熊明根，张世民，等．远端蒂皮瓣的静脉回流．中国临床解剖学杂志[J]，2001，19(2)：189～190
66.Timmons MJ. William Harvery revisited: reverse flow through the valves of the forearm vein?Lancet, 1984,2(6):394～395
67．张世民，刘大雄，张连生，等．远端蒂皮瓣的血液循环特征及临床意义．中国临床解剖学杂志[J]．1998，16(2)：103～106
68.Tanaka Y, Tajima S.The influence of arterial inflow and venous outflow on the survival of reversed-flow island fkaps: an experimental study. Plast Reconstr Surg, 1997,99(7):2021～2029
69.Cormack GC, Lamberty BGH.A classification of fascio-cutaneous flaps according to their patterns of vascularisation. Birt J Plast Surg, 1984,37(1):80～87
70.Del Pinal F, Taylor GI. The deep venous system and reverse flow flaps. Brit J Plast Surg, 1993,46(6):652～664
71．原林，钟世镇．皮瓣静脉构筑及交通的应用解剖学研究．中华显微外科杂志
72．原林，钟世镇．静脉动脉化皮瓣的有关解剖学问题．中华显微外科杂志[J]，1991，14(4)：240～241
73．原林，钟世镇．非生理性血液循环皮瓣的研究进展．中国临床解剖学杂志[J]，1991，9(2)：120～123
74.Nakajima H, Imanishi N, Fukuzumi S, et al. Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities,anatomical study and a concept of the venoadipofascial and/or neuroadipofascial pedicled fasciocutaneous flap. Plast Reconstr Surg, 1998,102(3):779～791
75.Shalaby HA,Saad MA.The venous island flap: is it purely venous ?Brit Plast Surg, 1993,46(3):285～287
76.Inoue Y, Taylor GI. The angiosomes of the forearm: anatomic study and clinical implications. Plast Reconstr Surg, 1996,98(2): 195～210
77．钟世镇，原林，徐达传，等．皮瓣静脉伴行不紧密类型及其临床意义．中国修复重建外科杂志[J]，1993，7(1)：1～2
78．钟世镇，原林，徐达传，等．皮瓣静脉干的类型及其选用原则．中华手外科杂志[J]，1994，10(2)：102～104
79．陈吕富，武义鸣，徐慧君，等．大隐静脉的调查研究．解剖学报[J]，1966；9(2)：273～280
80.Major John B, McCrow Usat. The dosalis pedis arterialized flap. Plast Reconstr Surg, 1975,55 (1) :177～191
81．梅芳瑞，李柏，宋丰，等．足背皮瓣游离移植12例报告．解剖军医学杂志[J]，1982，7(6)：367～369
82．陶凯忠，陈尔瑜．皮瓣的血管构筑．解剖科学进展[J]，1995，1(3)：231～236
83.Carriquiry CE. Versatile fasciocutaneous flaps based on the medial septocutaneous vessels of the arm..Plast Reconstr Surg, 1990,86(1): 103～109
84.Torri S, Naniki Y, Hayashi Y. Anterolateral leg island flap. Brit J Plast Surg, 1987,40(3):236～240
85.Carriquiry CE, Costa MA, Vasconez LO. The anatomic study of the the septocutaneous vessels of the leg. Plast Reconstr Surg, 1985,76(3):354～361
86.Beveridge J. Masquelet AC, Romana MC, et al. Anatomic basis of a fasciocutaneous falp supplied by the perforating branch of the peroneal artery. Surg Radiol Anat, 1988,10(3):195～199
87.Bertelli JA. Neurocutaneous island flaps in upper limb coverage: experience with 44 clinical cases. J Hand Surg, 1997,22A(3):515～526
88.Bertelli JA, Khoury Z. Neurocutaneous island flaps in the hand: anatomical basis and preliminary results. Brit J Plast Surg, 1992,45(8):586～590
89.Masquelet AC, Romana MC, Wolf G. Skin is. land flaps supplied by the vascular axis of the sensitive superficial nerve: anatomic study and clinical experience in the leg.Plast Reconstr Surg, 1992,89(6): 1115～1121
90.Taylor GI,Gianoutsos MP, Morris SF. The neurovascular territories of the skin and muscles:anatomic study and clinical implications.Plast Reconstr Surg, 1994,94(1):1～37
91.Nakajima H,FujinoT, Adachi S, et al. Venous drainage of the radial forearm and anterior tibial reverse flow flaps:anatomical and radiographic perfusion studies. Brit J Plast Surg, 1997,50(4):389～401
92．张世民，徐达传．带皮神经及其营养血管的皮瓣．中国临床解剖学杂志[J]，1996，14(4)：313～315
93．鲁开化，刘建波．轴型皮瓣研究与临床应用的进展．中华显微外科杂志[J]，1992，15(3)：136～138
94．王成琪．皮瓣的命名及供区选择．中华显微外科杂志[J]，1995，18(2)：84～85
95．钟世镇．开拓发展临床解剖学的实践认识．中国临床解剖学杂志[J]，2002，18(1)：3～4
96．钟世镇，孙博，刘牧之，等．皮瓣血供的解剖学类型．临床应用解剖学杂志[J]，1984，2(1)：1～5
97．庞水发，于国中，刘均墀，等．皮瓣移植修复组织缺损临床分析．中华显微外科杂志[J]，1999，22(2)：104～106
98.Chang SM, Chen ZW. Can superficial veins reverse flow through valves in distally based fasciocutaneous flaps ? Plast Reconstr Surg, 1991,87(5):995～996
99.Ballmer FT, Masquelet AC. The reversed～flow medio-distal fasciocutaneous island thigh flap:anatomic basis and clinical applications.Surg Radiol Anat, 1998,20(5):311～316
100.Goffin D, Bruneli F, Galbiatti A, et al. A new flap based on the distal branches of the radial artery. Ann Hand Surg, 1992,11:217～225
101.Lin SD, Lai CS, Chiu CC. Venous drainage in the reverse forearm flap. Plast Reconstr Surg, 1984,74(4):508～512
102.Lamberty BGH, Cormack GC. The forearm angiotomes. Brit J Plast Surg,1982,35(5):420～429
103．王成琪．皮瓣和肌皮瓣修复创伤性组织缺损的作用．中华显微外科杂志[J]，1999，22(1)：11～12
104．裴国献，赵东升．钟世镇，等．健侧胫后血管皮瓣桥携带游离皮瓣临床应用．中华显微外科杂志[J]，1999，22(1)：27～29
105．鲁开化，艾玉峰，郭树忠，等．显微外科技术对整形外科学科发展的促进与展望．中华显微外科杂志．2002，25(1)：10～11
106．刘兴炎，葛宝丰，甄平，等．吻合血管超长腓骨移植治疗胫骨严重粉碎性骨折．中华创伤杂志．2000，16(2)：86～87．
107．刘敏，田少斌。游离皮瓣移植临床应用分析．中华显微外科杂志．2002，25(1)：68～69．
108．王增涛，蔡锦方，曹学诚，等．拇趾腓侧皮瓣嵌入第二足趾改形法再造拇手指．中华手外科杂志．2002，18(1)：20～22．
109．马显杰，鲁开化，艾玉峰，等．颈横动脉颈段皮支皮瓣的显微外科解剖．中国临床解剖学杂志[J]，1994，12(2)：81～84
110．王炜，杨川，胡鸿泰，等．皮瓣移植存活血供条件及最低阈值研究．中华显微外科杂志[J]，1991，14(3)：146～151
111．罗力生，张立宪．胡志奇，等．高位直接皮支型股前外侧皮瓣的应用．中国修复重建外科杂志[J]，2001：15(4)：206～207
112．张春，吴恙，陈中，等．股前外侧皮瓣血管类型的临床观察与研究．中国临床解剖学杂志[J]，2001：19(3)：197～1999
2．钟世镇．我国显微外科进展有关的解剖学研究．中华手外科杂志[J]，1996，12(1)：1～3
3．钟世镇．组织瓣移植研究近况．中华手外科杂志[J]，1998，14(4)：193～195
4．朱家恺，庞水发．把我国显微外科推向21世纪新里程．中华显微外科杂志[J]，2000，20(1)：5～7
5.Harii K.Ohmori, K, Ohmori,S.Hair transplantation with free scalp flap. Plast Reconstr Sing, 1974,53(4):410～413
6.Daniel RK, Williams HB. The free transfer of skin flaps by microvascular anastomoses. Plast Reconstr Surg, 1973, 52(1):16～31
7．上海第一医学院华山医院口腔外科、手外科．带血管的游离皮瓣移植修复颊部缺损一例报告．中华医学杂志[J]，54：163
8．王成琪，王剑利，张敬良，等．皮瓣移植术的回顾与展望．中华显微外科杂志[J]，2000，23(1)：12～15
9．顾玉东．皮瓣进展20年(1973～1993)．中华外科杂志[J]，1994，10(2)：67～68
10．王渭滨，柳大烈，孟庆延，等．跨区互蒂轴型皮瓣的研究进展．中国临床解剖学杂志[J]，2000；18(4)：385～388
11．钟世镇．显微外科基础研究的回顾与展望．中华显微外科杂志[J]，2000，23(1)：8～9
12．钟世镇 主编．显微外科解剖学．北京：人民卫生出版社，1984
13.Taylor GI, Palmer JH. The vascular territories (angiosomes)of the body:experimental study and clinical applications. Brit J Plast Surg, 1987,40(2): 113～141
14.Taylor GI,Minabe T. The angiosomes of the mammals and other vertebrates.Plast Reconstr Surg, 1994,94(1): 1～37
15．顾玉东．皮瓣的静脉危象及其处理．中华手外科杂志[J]，1996，12(3)：131～133
16．钟世镇，孙博．皮瓣静脉回流解剖学研究概况．中华显微外科杂志[J]，1986，9(1)：47～49
17.Taylor GI, Caddy CM, Watterson PA, et al.The venous territories (venosomes)of the human body:experimental study and clinical implications. Plast Reconstr Surg, 1990,86(1):185～213
18．李忠华，王兴海主编．解剖学技术．北京：人民卫生出版社，1997
19．龚志锦，詹镕洲编著．病理组织制片和染色技术．上海：上海科学技术出版社，1994
20．钟世镇，徐达传．肢体血供规律与组织瓣设计的关系．中国临床解剖学杂志[J]，1996，14(3)：161～164
21．钟世镇，徐达传，刘牧之，等．缘支对阔筋膜张肌皮瓣的临床意义．临床应用解剖学杂志[J]．1984，2(3)：153～155
22.Haertsch PA. The surgical plane in the leg. Brit J Plast Surg, 1981,34(5):464～469
23．毛增荣，施恩娟，张成立，等．皮瓣的血管构筑．解剖学通报[J]，1984，7(2)：138～142
24．郭光金，陈尔瑜，陈维佩，等．腹部皮瓣的动脉及血管网构筑．解剖学报[J]，1992，23(2)：113～117
25．杨果凡，陈宝驹，高玉智，等．前臂皮瓣游离移植术．中华医学杂志[J]，1981，61(3)：139～141
26．钟世镇，徐达传．组织瓣的解剖学基础与命名的关系．中华手外科杂志[J]，1998，14(4)：194～196
27.Fujino T. Contribution of the axial and perforator vasculature to circulation in flaps.Plast Reconstr Surg, 1967,39(1): 125～137
28.Smith PJ. The importance of venous drainage in axial pattern falaps. Br J Plast Surg,1978(2),31:233～237
29.Su CT, Im MJ,Hoopers JE,et al. Tissue glucose and lactate following vascular occlusion in island skin flaps. Plast Reconstr Surg, 1982,70(2):202～205
30．福居显宏，玉井进，增原建二，他．有茎皮瓣延长静脉还流路意义．形成外科，1983；26(2)：164～173
31.Taylor GI,Pan WR.Angiosomes of the leg, anatomic study and clinical implications.Plast Reconstr Surg, 1998,102(3):599～616
32．钟世镇．组织瓣手术血供有关的解剖学要点．中国现代手术学杂志[J]，2001，5(2)：83～86
33.Timmons MJ.Landmarks in the anatomical study of the blood supply of the skin. Brit Plast Surg, 1985,38(2): 197～207
34．刘芬兰，张富安，关阑，等．腹部皮瓣的微血管构筑．局解手术学杂志[J]，1994，3(3)：5～10
35．柏树令，李吉．小腿后部皮瓣的微细血管构筑．解剖学通报[J]，1983，6(4)：334～339
36．李吉，刘志，李桂珍，等．大腿前部皮瓣微血管构筑．中国医科大学学报[J]，1989，18(1)：18～21
37．乔连铭，高振平，孙天恩，等．背阔肌皮瓣的微血管构筑．中国临床解剖学杂志[J]，1997，15(4)：276～279
38．高建华，罗锦辉．真皮下血管网皮瓣移植．中华整形烧伤外科杂志39．高建华，罗锦辉，百束比占，等．窄蒂并远端吻合血管的巨大枕颈背真皮下血管网薄皮瓣．中华整形烧伤外科杂志[J]，1997，13(2)：115～116
39．徐达传，钟世镇，刘牧之，等．股前外侧部皮瓣的解剖学．临床应用解剖学杂志[J]，1984，2(3)：158～160
40．肖添有，司徒朴，陈伯华，等．轴型血管蒂股前外侧真皮下血管网皮瓣的应用解剖．中国临床解剖学杂志[J]，1997，15(1)：7～9
41．肖添有，肖能坎，司徒朴，等．轴型真皮下血管网皮瓣的应用解剖．解剖学研究[J]，2001，23(1)：11～13
42．陈伯华，徐达传，司徒朴，等．颈肩肱部真皮下血管网皮瓣的解剖学基础．中国临床解剖学杂志[J]，1993，11(4)：245～248
43．李谆，原林，高岚，等．颈胸前筋膜皮瓣修复颈前瘢痕的解剖学研究．中国美容医学杂志[J]，2000，9(6)：331～333
44．宋业光，修志夫，张智勇，等．真皮下血管网薄皮瓣血管构筑变化与成纤维细胞生长因子的关系．中华整形烧伤外科杂志[J]，1996，12(5)：323～325
45．徐达传，钟世镇，何尚宽，等．筋膜骨膜骨瓣移位术的解剖学基础．中国临床解剖学杂志[J]，1990，8(4)：207～210
46．侯春林，张世民 编著．筋膜皮瓣与筋膜蒂组织瓣．上海：上海科学技术出版社，2001
47.Robotti E,Verna G, Fraccalvieri M,et al. Distally based fasciocutaneous flaps:a versatile option for coverage of difficult war wounds of the foot and ankle. Plast Reconstr Surg,,1998,101(4):1014～1021
48.Lamberty BGH, Cormack GC.Fasciocutaneous flaps. Clin Plast Surg,1990,17(6):713～726
49．马显杰，鲁开化，艾玉峰，等．跨区供血的轴型皮的成活机理的实验研究．解放军医学杂志[J]，1993，18(2)：91～93
50．王臻，鲁开化．跨区供血皮瓣与预构皮瓣血管化研究进展．中华显微外科杂志[J]，1997，20(3)：172～175
51.Cormack GC. Lamberty BGH.The blood supply of thigh skin.Plast 1985,75(3):342～354
52.Comack GC, Lamberty BGH. Cadaver study of correlation between vessel size and anatomical territory of cutaneous supply. Brit J Plast Surg, 1986,39(3):300～306
53．周礼荣，丁任，蔡仁祥，等．四肢皮神经营养血管皮瓣的临床应用．中华显微外科杂志[J]，2000，23(1)：26～28
54．侯之启，钟世镇，孙博．小腿皮瓣的静脉瓣研究．中华显微外科杂志[J]，1987；10(1)：29～30
55.Erdmann MW, Court-Brown CM, Quaba AA. A five year review of island distally based fasciocutaneous flaps on the lower limb. Brit J Plast Surg, 1997,50(6):421～427
56．鲁开化，钟德才，陈璧，等．前臂桡动脉逆行皮瓣及其临床应用．中华外科杂志[J]，1982，20(11)：695～697
57．孙博，刘牧之，原林，等．前臂桡侧岛状逆行旋转皮瓣静脉回流的解剖学研究．临床应用解剖学杂志[J]，1983，1(1)：8～12
58．孙博，钟世镇，郑玉明，等．前臂、小腿逆行皮瓣静脉回流的实验研究．显微医学杂志[J]，1985；8(3)：148～150
59．郑玉明，李运连，陈庄洪，等．前臂岛状皮瓣移位术在手外科的应用．解放军医学杂志，1983，8(3)：168～171
60．关桂春．小腿内侧岛状皮瓣逆行移位术解剖学所见．临床应用解剖学杂志[J]，1985，3(1)：9～10
61.Imanishi N, Nakajima H, Fukuzumi S, et al. Venous drainage of the distally based lesser spahenous-sural veno-neuroadipofascial pedicled fasiocutaneous flap: a radiographic perfusion study. Plast Reconstr Surg, 1999, 103(2):494～498
62.Budo, J, Finucan T, Clarke J. The inner arm fasciocutaneous flap. Plast Reconstr Surg, 1984,73(4):629～632
63．张世民，侯春林，徐瑞生，等．浅静脉干对四肢远端蒂皮瓣作用的实验研究．中国临床解剖学杂志[J],2001，19(2)：175～176
64．张世民，陈中伟．前臂远端蒂筋膜皮瓣的静脉回流．手外科杂志[J]，1992，8(2)：72～73
65．康安，熊明根，张世民，等．远端蒂皮瓣的静脉回流．中国临床解剖学杂志[J]，2001，19(2)：189～190
66.Timmons MJ. William Harvery revisited: reverse flow through the valves of the forearm vein?Lancet, 1984,2(6):394～395
67．张世民，刘大雄，张连生，等．远端蒂皮瓣的血液循环特征及临床意义．中国临床解剖学杂志[J]．1998，16(2)：103～106
68.Tanaka Y, Tajima S.The influence of arterial inflow and venous outflow on the survival of reversed-flow island fkaps: an experimental study. Plast Reconstr Surg, 1997,99(7):2021～2029
69.Cormack GC, Lamberty BGH.A classification of fascio-cutaneous flaps according to their patterns of vascularisation. Birt J Plast Surg, 1984,37(1):80～87
70.Del Pinal F, Taylor GI. The deep venous system and reverse flow flaps. Brit J Plast Surg, 1993,46(6):652～664
71．原林，钟世镇．皮瓣静脉构筑及交通的应用解剖学研究．中华显微外科杂志
72．原林，钟世镇．静脉动脉化皮瓣的有关解剖学问题．中华显微外科杂志[J]，1991，14(4)：240～241
73．原林，钟世镇．非生理性血液循环皮瓣的研究进展．中国临床解剖学杂志[J]，1991，9(2)：120～123
74.Nakajima H, Imanishi N, Fukuzumi S, et al. Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities,anatomical study and a concept of the venoadipofascial and/or neuroadipofascial pedicled fasciocutaneous flap. Plast Reconstr Surg, 1998,102(3):779～791
75.Shalaby HA,Saad MA.The venous island flap: is it purely venous ?Brit Plast Surg, 1993,46(3):285～287
76.Inoue Y, Taylor GI. The angiosomes of the forearm: anatomic study and clinical implications. Plast Reconstr Surg, 1996,98(2): 195～210
77．钟世镇，原林，徐达传，等．皮瓣静脉伴行不紧密类型及其临床意义．中国修复重建外科杂志[J]，1993，7(1)：1～2
78．钟世镇，原林，徐达传，等．皮瓣静脉干的类型及其选用原则．中华手外科杂志[J]，1994，10(2)：102～104
79．陈吕富，武义鸣，徐慧君，等．大隐静脉的调查研究．解剖学报[J]，1966；9(2)：273～280
80.Major John B, McCrow Usat. The dosalis pedis arterialized flap. Plast Reconstr Surg, 1975,55 (1) :177～191
81．梅芳瑞，李柏，宋丰，等．足背皮瓣游离移植12例报告．解剖军医学杂志[J]，1982，7(6)：367～369
82．陶凯忠，陈尔瑜．皮瓣的血管构筑．解剖科学进展[J]，1995，1(3)：231～236
83.Carriquiry CE. Versatile fasciocutaneous flaps based on the medial septocutaneous vessels of the arm..Plast Reconstr Surg, 1990,86(1): 103～109
84.Torri S, Naniki Y, Hayashi Y. Anterolateral leg island flap. Brit J Plast Surg, 1987,40(3):236～240
85.Carriquiry CE, Costa MA, Vasconez LO. The anatomic study of the the septocutaneous vessels of the leg. Plast Reconstr Surg, 1985,76(3):354～361
86.Beveridge J. Masquelet AC, Romana MC, et al. Anatomic basis of a fasciocutaneous falp supplied by the perforating branch of the peroneal artery. Surg Radiol Anat, 1988,10(3):195～199
87.Bertelli JA. Neurocutaneous island flaps in upper limb coverage: experience with 44 clinical cases. J Hand Surg, 1997,22A(3):515～526
88.Bertelli JA, Khoury Z. Neurocutaneous island flaps in the hand: anatomical basis and preliminary results. Brit J Plast Surg, 1992,45(8):586～590
89.Masquelet AC, Romana MC, Wolf G. Skin is. land flaps supplied by the vascular axis of the sensitive superficial nerve: anatomic study and clinical experience in the leg.Plast Reconstr Surg, 1992,89(6): 1115～1121
90.Taylor GI,Gianoutsos MP, Morris SF. The neurovascular territories of the skin and muscles:anatomic study and clinical implications.Plast Reconstr Surg, 1994,94(1):1～37
91.Nakajima H,FujinoT, Adachi S, et al. Venous drainage of the radial forearm and anterior tibial reverse flow flaps:anatomical and radiographic perfusion studies. Brit J Plast Surg, 1997,50(4):389～401
92．张世民，徐达传．带皮神经及其营养血管的皮瓣．中国临床解剖学杂志[J]，1996，14(4)：313～315
93．鲁开化，刘建波．轴型皮瓣研究与临床应用的进展．中华显微外科杂志[J]，1992，15(3)：136～138
94．王成琪．皮瓣的命名及供区选择．中华显微外科杂志[J]，1995，18(2)：84～85
95．钟世镇．开拓发展临床解剖学的实践认识．中国临床解剖学杂志[J]，2002，18(1)：3～4
96．钟世镇，孙博，刘牧之，等．皮瓣血供的解剖学类型．临床应用解剖学杂志[J]，1984，2(1)：1～5
97．庞水发，于国中，刘均墀，等．皮瓣移植修复组织缺损临床分析．中华显微外科杂志[J]，1999，22(2)：104～106
98.Chang SM, Chen ZW. Can superficial veins reverse flow through valves in distally based fasciocutaneous flaps ? Plast Reconstr Surg, 1991,87(5):995～996
99.Ballmer FT, Masquelet AC. The reversed～flow medio-distal fasciocutaneous island thigh flap:anatomic basis and clinical applications.Surg Radiol Anat, 1998,20(5):311～316
100.Goffin D, Bruneli F, Galbiatti A, et al. A new flap based on the distal branches of the radial artery. Ann Hand Surg, 1992,11:217～225
101.Lin SD, Lai CS, Chiu CC. Venous drainage in the reverse forearm flap. Plast Reconstr Surg, 1984,74(4):508～512
102.Lamberty BGH, Cormack GC. The forearm angiotomes. Brit J Plast Surg,1982,35(5):420～429
103．王成琪．皮瓣和肌皮瓣修复创伤性组织缺损的作用．中华显微外科杂志[J]，1999，22(1)：11～12
104．裴国献，赵东升．钟世镇，等．健侧胫后血管皮瓣桥携带游离皮瓣临床应用．中华显微外科杂志[J]，1999，22(1)：27～29
105．鲁开化，艾玉峰，郭树忠，等．显微外科技术对整形外科学科发展的促进与展望．中华显微外科杂志．2002，25(1)：10～11
106．刘兴炎，葛宝丰，甄平，等．吻合血管超长腓骨移植治疗胫骨严重粉碎性骨折．中华创伤杂志．2000，16(2)：86～87．
107．刘敏，田少斌。游离皮瓣移植临床应用分析．中华显微外科杂志．2002，25(1)：68～69．
108．王增涛，蔡锦方，曹学诚，等．拇趾腓侧皮瓣嵌入第二足趾改形法再造拇手指．中华手外科杂志．2002，18(1)：20～22．
109．马显杰，鲁开化，艾玉峰，等．颈横动脉颈段皮支皮瓣的显微外科解剖．中国临床解剖学杂志[J]，1994，12(2)：81～84
110．王炜，杨川，胡鸿泰，等．皮瓣移植存活血供条件及最低阈值研究．中华显微外科杂志[J]，1991，14(3)：146～151
111．罗力生，张立宪．胡志奇，等．高位直接皮支型股前外侧皮瓣的应用．中国修复重建外科杂志[J]，2001：15(4)：206～207
112．张春，吴恙，陈中，等．股前外侧皮瓣血管类型的临床观察与研究．中国临床解剖学杂志[J]，2001：19(3)：197～1999