逆行缝匠肌皮瓣修复小腿皮肤缺损的解剖和初步应用  

The anatomy and clinical application of retrograde sartoriusmyocutaneous flap for reparing skin defects of leg

作　　者：左荣跃[1] 史增元[1] 尹维刚[2] 陈一勇[2] 毛海蛟[1] 刘振新[1] 俞森[1] 

机构地区：[1]宁波大学医学院附属医院骨科,浙江省宁波市315020 [2]宁波大学解剖学教研室

出　　处：《中华显微外科杂志》2017年第2期161-164,共4页Chinese Journal of Microsurgery

基　　金：宁波市社会发展计划项目（2011C50006）

摘　　要：目的探讨逆行缝匠肌皮瓣修复小腿皮肤缺损的解剖与手术方法。方法用50侧经动脉灌注红色乳胶的成尸下肢标本，解剖观测缝匠肌的动脉来源、外径、走形、分布及吻合。取4侧新鲜尸体下肢标本进行动脉造影，观察缝匠肌肌内动脉吻合。设计逆行缝匠肌皮瓣修复小腿皮肤缺损。结果营养动脉呈节段性进入缝匠肌，相邻节段动脉的分支在肌内形成链型吻合。节段动脉发出皮动脉和肌皮动脉营养缝匠肌及表面皮肤。隐动脉营养缝匠肌下2/5段，并参与膝关节动脉网，为逆行缝匠肌皮瓣的供血动脉。2010年2月至2014年4月，临床应用该肌皮瓣2例，肌皮瓣切取范围7 cm×18 cm- 12 cm×25 cm，术后皮瓣均成活，随访7- 16个月，皮瓣色泽、质地良好，无肿胀、破溃、骨折愈合，皮瓣外观较为满意。结论逆行缝匠肌皮瓣解剖位置恒定，血供可靠，手术简便，是修复小腿中、上段皮肤缺损的一种有效方法。ObjectiveTo investigate the effect of retrograde sartorius myocutaneous flap for reparing skin defects of leg.MethodsIn the anatomic study, 50 cadaveric lower limb were injected with red latex and the origin, diameter, course, distribution and anastomosis of sartorius＇s arteries were observed. Arteriographies were made in 4 sides of fresh specimens to study the arterial anastomosis in sartorius. Based on anatomic research results, we designed the retrograde sartorius myocutaneous flap for reparing skin defects of leg.ResultsNutrient arteries of sartorius represented segmental distribution, Link-pattern arterial anastomosises were formed in sartorius by branches of adjacent vascular pedicles. Cutaneous arteries and musculocutaneous arteries above deep fascia formed interlocking arterial anastomosises net which provided blood supply for the skin on sartorius. The arterial branches in the distal 2/5 of sartorius came from saphenous artery, composed an arterial network around knee joint, which consist of anatomic basis for the blood supply of retrograde sartorius myocutaneous flap. Form February, 2010 to April, 2014, the retrograde sartorius myocutaneous flap were used to repair skin defects of leg in 2 cases. The flap size ranged from 7 cm×18 cm to 12 cm×25 cm. All flaps survived successfully with no ulcer. 2 cases were followed up for 7 to 16 months. The skin color and texture were satisfactory.Conclusionthe retrograde sartorius myocutaneous flap has constantly, reliable blood supply, and easily performed. It is an effective method for the reconstruction skin defects of leg.

关 键 词：缝匠肌 外科皮瓣 隐动脉 小腿: 皮肤缺损 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R658.3[医药卫生—基础医学]