Introduction

Cartilage repair usually involves in non-vascularized osteochondral or chondral grafts with some drawbacks potentially linked to the lack of vascular supply in those grafts. The aim of this study was to describe a surgical approach for harvesting a vascularized chondrocostal graft, to study the vascular supply to the perichondrium and finally to describe the perichondrium micro-vascularization in order to know how such grafts could be used in cartilage repair surgery.

Materials and methods

We harvested and studied 18 costal cartilages harvested from 12 fresh anatomical subjects. The anatomic pieces were injected with a radio-opaque tracer, analyzed macroscopically, then a plain X-rays and CT scan analysis with three-dimensional rendering was performed in order to evaluate the characteristics of the different patterns of their vascularization.

Results

The surgical approach to harvest a vascularized 5th chondrocostal graft is explained in detail. All of the cartilages were vascularized by the internal thoracic artery and harvested with a pedicle of an average length of 34 mm and diameter of 2.14 mm. In all specimens, perichondrium vascularization arises from both superior and inferior intercostal branches. Anastomoses between inferior and superior intercostal branches are always found in all specimens at the level of the epichondrium.

Conclusions

The anatomic approach for harvesting a vascularized chondrocostal graft is simple and only slightly differs from the approach described for harvesting a non-vascularized chondrocostal graft. The vascular supply to the perichondrium of such a vascularized chondrocostal graft is sustained by the internal thoracic vessels which have a sufficient diameter and length to allow easy micro-anastomosis. The organization of the micro-vasculature within the perichondrium allows the graft to be tailored to a large cartilage defects and also to small bipolar cartilage defects.

中文翻译：

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人体肋软骨：宏观血管化和微血管化的解剖学和放射学研究及其在血管化软骨肋游离皮瓣手术中的临床意义。

介绍

软骨修复通常涉及非血管化的骨软骨或软骨移植，其缺点可能与这些移植物中缺乏血管供应有关。这项研究的目的是描述一种手术方法，以收集血管化的软骨肋移植物，研究对软骨膜的血管供应，最后描述软骨膜的微血管化，从而了解如何将这种移植物用于软骨修复手术。

材料和方法

我们收获并研究了从12位新鲜的解剖对象中收获的18条肋软骨。将不透射线的示踪剂注入解剖切片，进行宏观分析，然后进行普通X射线和三维渲染的CT扫描分析，以评估其不同血管形成方式的特征。

结果

详细介绍了收集血管化的第五肋软骨移植物的手术方法。所有的软骨均由胸内动脉血管化，并用平均长度为34 mm，直径为2.14 mm的椎弓根进行收获。在所有标本中，软骨膜血管化都来自肋间上支和下支。在所有的标本中，总是在表皮水平上发现下肋间分支和上肋间分支之间的吻合。

结论

收集血管化的软骨肋移植物的解剖学方法很简单，并且与所述的非血管化的软骨肋移植物的收获方法略有不同。这种具有血管的软骨肋移植物向软骨膜的血管供应由胸内血管维持，该胸内血管具有足够的直径和长度以允许容易的微吻合。软骨膜内微血管的组织使移植物适合于大软骨缺损以及小的双相软骨缺损。