阴股沟皮瓣应用解剖学研究

目的明确阴股沟皮瓣的解剖学基础.方法对10具(20侧)成年女尸阴股沟区皮肤进行解剖学研究.结果阴股沟皮瓣存在多重血液供应;其中,闭孔动脉前皮支分布于皮瓣中部,浅出点距会阴正中线(3.0±0.5)cm,距阴道口前缘(1.7±0.4)cm距耻骨下支外侧缘(0.6±0.2)cm,管径(0.8±0.1)mm;阴唇后动脉主要供应大阴唇,并恒定地以本干的形式在大阴唇皮下与阴部外浅动脉形成血管吻合,在阴道口后缘前后各1.5cm的范围内,发出2、3支阴唇后动脉外侧支,外径为(0.7±0.3)mm,分布于阴股沟皮瓣后部;阴部外浅动脉斜形穿过皮瓣上端走向大阴唇,沿途发出柳枝状血管分支分布于皮瓣上端.结论阴股沟皮瓣阴道再造所利用的血管是阴唇后动脉外侧支,而非阴唇后动脉主干;由于闭孔动脉前皮支浅出点位置较高而且固定,以之为蒂形成的皮瓣不适用于阴道再造,而适合于会阴部较小皮肤缺损的修复.

Applied anatomic study of the pudendal-thigh flap and establishment of flap model

OBJECTIVE: To investigate the anatomic base of the pudendal-thigh flap and establish flap model. METHODS: Skin dissection of pudendal-thigh regions was performed on 10 cadavers (20 sides). All afferent and efferent vessels were measured and recorded. RESULTS: There exist multiple blood supplies of pudendal-thigh flap. Anterior cutaneous branches of obturator artery spread out on middle portion of flap. Piercing site of it is (3.0 +/- 0.5) cm apart from middle line of perineum, (1.7 +/- 0.4) cm from anterior margin of vaginal introitus, (0.6 +/- 0.2) cm from outer fringe of lower pubic rami and (0.8 +/- 0.1) mm in diameter. Posterior labial arteries mainly supply the major labia and constantly anastomose with superficial external pudendal arteries in direct vascular anastomosis in subcutis of major labia. The main stems send out 2-3 lateral branches of posterior labial arteries which distribute to posterior portion of the pudendal-thigh flap. CONCLUSION: The major vessels of pudendal-thigh flaps used to form a neovagina are lateral branches of posterior labial arteries and not the main stem itself. Flaps pedicled on the anterior cutaneous branches of obturator arteries may be elevated to repair rectovaginal fistula or small skin defects of perineum and not suited to reconstruct a neovagina as its piercing point of blood vessels is much higher and the location of pedicle is more fixed.