股前内侧穿支皮瓣血管解剖及临床应用  

Perforator vascular anatomy and clinical application of the anteromedial thigh flap for head and neck reconstruction

作　　者：徐中飞[1] 张恩礁[1] 段维轶[1] 代炜[1] 刘法昱[1] 戚忠政[1] 谭学新[1] 黄绍辉[1] 孙长伏[1] 

机构地区：[1]中国医科大学口腔医学院口腔颌面-头颈肿瘤外科研究室,口腔颌面外科教研室,辽宁省口腔医学研究所

出　　处：《上海口腔医学》2013年第6期690-694,共5页Shanghai Journal of Stomatology

摘　　要：目的:对股前内侧区可用穿支进行临床解剖研究,并应用此皮瓣进行头颈肿瘤术后缺损的修复重建,评价其可靠性、优缺点及临床价值。方法:探查54例股前内侧皮瓣穿支血管,其中40例与制取股前外侧皮瓣的病例同时进行,14例为直接制取。详细记录术中探查皮肤厚度,可用穿支的位置、口径、数量、血管来源等情况,采用SPSS13.0软件包对数据进行统计学处理,并对14例股前内侧皮瓣的制取方法进行总结,评价其可靠性及在头颈部修复重建中的优缺点。结果:54例中,46例探查到可用穿支血管共56支,其中隔皮穿支40.9%(25/61),肌皮穿支59.1%(36/61)。穿支血管距髂前上棘的距离平均为(22.5±2.38)cm,距髂前上棘与髌骨外上缘连线的距离平均为(3.9±0.72)cm,95.1%(58/61)的穿支血管位于大腿中1/3区域。14例皮瓣的血管蒂均为旋股外侧动脉降支的内侧支。股前外侧穿支皮瓣(ALT)和股前内侧穿支皮瓣(AMT)可用穿支数呈负相关(P<0.01)。所有皮瓣均完全成活,创口一期愈合,术后供区及受区功能恢复满意。结论:旋股外侧动脉降支的内侧支是股前内侧穿支皮瓣的血管蒂,当股前外侧区无可用的穿支血管时,股前内侧皮瓣通常是可利用的,股前内侧皮瓣既可以作为头颈重建的主力皮瓣,也可作为股前外侧皮瓣的备选皮料。PURPOSE： A clinical study was undertaken to define the vascular anatomy of anteromedial thigh perforator flap （AMT） and evaluate the outcomes of the flap in head and neck reconstruction. METHODS： The sizable perforators of AMT flaps and their origins were prospectively explored in 54 patients. For each patient, we recorded the sizable perforators＇ location, diameter, source vessel, numbers and anatomical types. Among them, 14 cases underwent head and neck reconstruction with AMT flaps. The complications and functions of donor and recipient sites were recorded and the operative techniques of AMT were described. Statistical analysis was performed with SPSS 13.0 software package. RESULTS： Eight of fifty-four thighs had no sizable AMT perforators. AMT flap was based on the medial branch of descending branch of lateral circumflex femoral artery （d-LCFA） and shared the same vascular pediele with anterolateral thigh flap （ALT）. The total sizable perforators were 56. Among them, 40.9%（25/61） were direct septoeutaneous perforators, the remaining perforators were all musculoeutaneous. Most of the sizable perforators （58/61, 95.1%） were located in the middle one-third of the thigh, with an average of （3.9＋0.72） cm medial to a line connecting the anterior superior iliac spine and the superolateral patella and an average of （22.5_＋2.38） cm to anterior superior iliac spine. There was an negtive relationship between the number of sizable perforators of AMT and ALT flaps （P〈0.01）. 14 flaps survived completely. No complications were observed in recipient and donor site. CONCLUSIONS： The pedicle of AMT flap is the medial branch of d-LCFA. The AMT flap may be useful if ALT flap is without sizable perforators. AMT flap may be as a primmy or an ahemative choice of anterolateral thigh flap ibr head and neck reconstruction.

关 键 词：股前内侧皮瓣 股前外侧皮瓣 穿支 头颈重建 

分 类 号：R622.1[医药卫生—整形外科] R739.86[医药卫生—外科学]