股前内侧穿支皮瓣血管解剖及临床应用

上海口腔医学 ›› 2013, Vol. 22 ›› Issue (6): 690-694.

股前内侧穿支皮瓣血管解剖及临床应用

徐中飞，张恩礁，段维轶，代炜，刘法昱，戚忠政，谭学新，黄绍辉，孙长伏

(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，辽宁沈阳 110002)

收稿日期:2013-02-27 修回日期:2013-05-10 出版日期:2013-04-12 发布日期:2013-04-12
通讯作者: 孙长伏，E-mail：changfusun@hotmail.com
作者简介:徐中飞(1976-)，男，副教授、副主任医师, E-mail：xzf7090@hotmail.com

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

XU Zhong-fei, ZHANG En-jiao, DUAN Wei-yi, DAI Wei, LIU Fa-yu, QI Zhong-zheng, TAN Xue-xin, HUANG Shao-hui, SUN Chang-fu

Department of Oromaxillofacial Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research. Shenyang 110002, Liaoning Province, China

Received:2013-02-27 Revised:2013-05-10 Online:2013-04-12 Published:2013-04-12

摘要/Abstract

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。

关键词: 股前内侧皮瓣, 股前外侧皮瓣, 穿支, 头颈重建

Abstract: 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 pedicle with anterolateral thigh flap (ALT). The total sizable perforators were 56. Among them, 40.9%(25/61) were direct septocutaneous perforators, the remaining perforators were all musculocutaneous. 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 primary or an alternative choice of anterolateral thigh flap for head and neck reconstruction.

Key words: Anteromedial thigh flap, Anterolateral thigh flap, Perforator, Head and neck, Reconstruction

中图分类号:

徐中飞, 张恩礁, 段维轶, 代炜, 刘法昱, 戚忠政, 谭学新, 黄绍辉, 孙长伏. 股前内侧穿支皮瓣血管解剖及临床应用[J]. 上海口腔医学, 2013, 22(6): 690-694.

XU Zhong-fei, ZHANG En-jiao, DUAN Wei-yi, DAI Wei, LIU Fa-yu, QI Zhong-zheng, TAN Xue-xin, HUANG Shao-hui, SUN Chang-fu. Perforator vascular anatomy and clinical application of the anteromedial thigh flap for head and neck reconstruction[J]. Shanghai Journal of Stomatology, 2013, 22(6): 690-694.

参考文献

[1] 邱蔚六. 口腔颌面外科临床进展一瞥[J]. 中国实用口腔科杂志, 2009, 2(1): 1-4.
[2] Lutz BS, Wei FC. Microsurgical workhorse flaps in head and neck reconstruction[J]. Clin Plast Surg, 2005, 32(3): 421-430.
[3] Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle[J]. Br J Plast Surg, 1989, 42(6): 645-648.
[4] Dancey A, Blondeel PN. Technical tips for safe perforator vessel dissection applicable to all perforator flaps[J]. Clin Plast Surg, 2010, 37(4): 593-606.
[5] Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps[J]. Plast Reconstr Surg, 2002, 109(7): 2219-2226.
[6] Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction[J]. Head Neck, 2004, 26(9): 759-769.
[7] 徐中飞, 代炜, 张恩礁, 等. 股前外侧穿支嵌合皮瓣修复头颈肿瘤根治术后缺损[J]. 上海口腔医学, 2012, 21(1): 107-112.
[8] Yu P, Selber J. Perforator patterns of the anteromedial thigh flap[J]. Plast Reconstr Surg, 2011, 128(3): 151e-157e.
[9] Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery[J]. Br J Plast Surg, 1984, 37(2): 149-159.
[10] 康庆林, 曾炳芳, 柴益民, 等. 以旋股外侧动脉降支为蒂的股前外侧和内侧双叶皮瓣移植术[J]. 中华骨科杂志, 2007, 27(8): 600-603.
[11] 王铠, 谭宏宇, 吴汉江, 等. 以旋股外侧动脉降支为蒂的穿支嵌合皮瓣修复口腔颌面部缺损[J].中华整形外科杂志,2009,25(6): 422-424.
[12] 徐中飞, 刘法昱, 谭学新, 等. 股前内侧穿支皮瓣: 一个理想的股前外侧皮瓣补救皮瓣[J]. 上海口腔医学,2011,20(5):535-539.
[13] Schoeller T, Huemer GM, Shafighi M, et al. Free anteromedial thigh flap: clinical application and review of literature[J]. Microsurgery, 2004, 24(1): 43-48.
[14] Hsieh CH, Yang JC, Chen CC, et al. Alternative reconstructive choices for anterolateral thigh flap dissection in cases in which no sizable skin perforator is available[J]. Head Neck, 2009, 31(5): 571-575.
[15] Xu ZF, SUN CF, Duan WY, et al. Clinical anatomical study and evaluation of the use of the free anteromedial thigh perforator flaps in reconstructions of the head and neck[J]. Br J Oral Maxillofac Surg,2013,51(8):725-730.
[16] Wei FC, Mardini S. Free-style free flaps[J]. Plast Reconstr Surg, 2004, 114(4): 910-916.
[17] 徐中飞, 段维轶, 尚德浩, 等. 游离股前外侧穿支皮瓣制取中多普勒的应用价值[J]. 中华口腔医学杂志, 2011, 46(5): 290-292.
[18] Yu P, Selber J, Lin J. Reciprocal dominance of the anterolateral and anteromedial thigh flap perforator anatomy[J]. Ann Plast Surg,2013,70(6):714-716.