游离股内侧肌穿支皮瓣的解剖研究与临床应用

目的研究股内侧肌肌皮穿支解剖学特征,设计游离股内侧肌穿支皮瓣,为临床修复软组织缺损提供一种新的皮瓣。方法取6具自愿捐献的新鲜成人下肢标本,以氧化铅混合红色乳胶灌注,解剖股内侧肌肌皮穿支,并通过血管造影技术观测股内侧肌肌皮穿支的起源、走行、分布情况。根据解剖研究,于2009年6月-2011年8月,临床采用大小为14 cm×6 cm～20 cm×5 cm的股内侧肌穿支皮瓣修复4例足部皮肤软组织缺损,缺损范围8 cm×6 cm～12 cm×8 cm。结果股动脉恒定发出的股内侧肌动脉在内侧肌内下行至髌旁,终末支与旋股外侧动脉终末支吻合形成髌周血管网。沿途发出3～5支粗大肌皮穿支达深筋膜内,并浅出至股内侧肌表面皮肤,构成股内侧血管网。临床应用4例股内侧肌穿支皮瓣均成活,受区创面及供区切口均Ⅰ期愈合;患者均获随访,随访时间6～12个月,皮瓣色泽、质地良好,踝关节背伸、跖屈活动范围正常。结论游离股内侧肌穿支皮瓣切取简便,皮瓣供区隐蔽,质地优良,是理想的皮瓣供区。

ANATOMIC STUDY ON PERFORATING BRANCH FLAP OF MEDIAL VASTUS MUSCLE AND ITS CLINICAL APPLICATION

Objective To investigate the anatomic features of the perforating branch flap of the medial vastus muscle,so as to provide a new perforating branch flap for repairing the soft tissue defect.Methods Six fresh donated lower limbspecimens underwent an intra-arterial injection of a lead oxide and lactoprene preparation.The integument of the thigh wasdissected to observe the origin,course,size,and location of the perforating branch of the medial vastus muscle by angiographyand photography.Based on the anatomic study,the free perforating branch flaps of the medial vastus muscle(14 cm × 6 cmto 20 cm × 5 cm) were used to repair skin and soft tissue defects(8 cm × 6 cm to 12 cm × 8 cm) of the feet in 4 patientsbetween June 2009 and August 2011.Results The artery of the medial vastus was sent out constantly from the femoralartery,and then descended in the vastus muscle to lateral patella where it anastomosed with the terminal branches of lateralfemoral circumflex artery to form prepatellar vascular network.The artery of the medial vastus sent out 3-5 musculocutaneousperforating branches into the deep fascia and then extended superficially to the overlying skin.Four flaps survived aftersurgery;wounds at the donor site and recipient site healed by first intention.After follow-up of 6-12 months,the flaps hadgood appearance and texture.All ankles had normal movement range of plantarflexion and dorsiflexion.Conclusion Thefree perforating branch flaps of the medial vastus muscle can be harvested easily,and have the advantage of good texture andabundant donor site.