同体两侧股前外侧皮瓣的解剖学对比

doi:10.16098/j.issn.0529-1356.2019.03.013

摘要/Abstract

摘要：

目的探讨同体两侧股前外侧（ALT）皮瓣的解剖学差异，为术前进行供侧大腿选择的必要性提供解剖学依据。方法 10具新鲜尸体标本（共20例）上行双侧ALT皮瓣制取，寻找皮瓣的营养穿支，记录穿支类型和数量，并逆向追溯到血管蒂；测量各穿支、血管蒂的长度和管径，统计学数据采用均值±标准差。结果 10具标本中有3具两侧股前外侧皮瓣为肌间隔穿支和肌皮穿支双供血型；其余7具两侧穿支类型不同。7具标本两侧皮瓣的穿支数量不同，另外3具的穿支数量相同。肌间隔穿支走行于股直肌与股外侧肌之间的肌间隙内，肌皮穿支或垂直或斜形穿过股外侧肌，其穿支长度各异。皮瓣穿支全部发自旋股外侧动脉（LCFA）降支的有14例，另有6例（30%，源于5具标本）皮瓣既有降支又有斜支参与供血，其中1具标本两侧均由斜支与降支双重供血，其余4具标本均只有1侧为斜支与降支双重供血。10具标本共20例皮瓣的两侧主要穿支和血管蒂管径及长度差别不大(P>0.05)。结论同体两侧股前外侧皮瓣的营养穿支在类型、数量、走行、血管蒂来源上存在差异，穿支的种类及走行对于皮瓣制取的难易及操作时间有直接影响。术前进行供侧大腿的选择有助于股前外侧皮瓣精准、快捷的制取。

关键词: 股前外侧皮瓣, 解剖学变异, 穿支皮瓣, 血管蒂, 大体解剖, 人

Abstract:

Objective To study the anatomic variation of bilateral anterolateral thigh（ALT）flap, serving as an anatomical basis for the necessity of preoperative selection of donor thigh. Methods Ten fresh cadavers（20 cases）were recruited for the fabrication of bilateral ALT flap. The nutrient perforating branches of each flap were found out and then traced reversely to the vascular pedicle. The type and the number of perforating branches were recorded,and the length and diameter of the perforator and vascular pedicle was measured. Statistic data was expressed as x±s. Results Three cadavers were found that the bilateral ALT flap were nourished by both septocutaneous and musculocutaneous perforators, while the other 7 cadavers were found not feeded by the exactly same perforator in types bilaterally. Only 3/10 of the cadavers were noticed sharing the same number of perforator bilaterally, while the remnant 70% not. All the septocutaneous perforators pass through the intermuscular septum between the vastus lateralis and rectus femoris muscle,and all the musculocutaneous perforators penetrate vertically or obliquely into the vastus lateralis. Perforators derived solely from descending branch of lateral femoris circumflex artery(LCFA) were observed in 14 cases. The other 6 cases, 2 of which from 1 cadaver bilaterally and 4 of which from 4 cadavers unilaterally, saw that both oblique branch and descending branch of LCFA gave off perforators into the flap. The length and diameter of each main perforator and vascular pedicle in 10 cadavers bilaterally were not different signific antly(P>0.05). Conclusion Nutritive perforating branch of bilateral ALT flap differed in type, number, course and pedicle sourse，which has direct effects on the difficulty of flap fabrication and the duration of operation. Preoperative selection of donor thigh is helpful for safe and rapid preparation of anterolateral thigh flap.

Key words: Anterolateral thigh flap, Anatomic variation, Perforator flap, Vescular pedicle, Gross anatomy, Human

张小辉孟凡皓朱智慧王乃利马超曹承刚张韬. 同体两侧股前外侧皮瓣的解剖学对比[J]. 解剖学报, 2019, 50(3): 340-345.

ZHANG Xiao-hui MENG Fan-hao ZHU Zhi-hui WANG Nai-li MA Chao CAO Cheng-gang ZHANG Tao. Anatomical comparison of bilateral anterolateral thigh flap[J]. Acta Anatomica Sinica, 2019, 50(3): 340-345.

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