臀上皮神经营养血管筋膜皮瓣移植的应用解剖特点

背景：臀上皮神经营养血管筋膜皮瓣是一类以皮神经血供为其成活基础的新型皮瓣，皮神经周围的营养血管在营养神经的同时发支营养其周围的筋膜皮肤。此皮瓣可以用最小的副损伤修复骶部压疮，并且皮瓣有感觉。 目的：拟通过对臀上皮神经筋膜皮瓣进行应用解剖学分析，为臀上皮神经筋膜移植皮瓣及其旋转点的精确设计提供解剖学依据。 设计、时间及地点：应用解剖学实验，于2006-03/05在大连医科大学解剖教研室及大连大学医学院解剖教研室完成。 对象：选取31侧用红色乳胶灌注、经甲醛固定的中国成人人体臀部标本。 方法：解剖成人人体臀部标本臀上动脉的肌皮穿支并测量其外径，解剖臀上皮神经和第4腰动脉后支观察其在深筋膜穿出点的位置，测量臀上皮神经中支的长度及第4腰动脉后支的外径。 主要观察指标：臀上皮神经筋膜移植皮瓣的解剖学数据。 结果：臀上皮神经中支长度（15.1±1.4）cm（n=31）。臀上皮神经中支支配区有效长度（13.3±1.5）cm（n=31）。臀上皮神经、第4腰动脉后支出肌点距髂嵴上缘距离（8.5±1.1）mm（n=31）。臀上皮神经、第4腰动脉后支出肌点距后正中线距离（7.1±1.6）cm（n=31）。第4腰动脉后支外径（1.0±0.3）mm（n=31）。臀上动脉上支的肌皮穿支外径：第1支（0.52±0.22）mm（n=15），第2支（0.42±0.18）mm（n=10）。 结论：臀上皮神经筋膜皮瓣的旋转点设计应距后正中线(7.1±1.6) cm，距髂嵴上缘(8.5±1.1) mm。臀上皮神经筋膜皮瓣宜以长度(13.3±1.5) cm，蒂部宽度3.5 cm为宜。

Applied anatomical characteristics of superior clunial fascio-cutaneous flap pedicled with cutaneous nerve and nutrient vessel

BACKGROUND: Superior cluneal fascio-cutaneous flap pedicled with cutaneous nerve and nutrient vessel is a kind of new flap which survives depending on the blood vessels close to the cutaneous nerve. These blood vessels supply not only the nerves but also the fiscia and skin around them. The flap with sensation can be used to treat decubitus ulcers in sacrum region with minimum additional damage. OBJECTIVE: To study the anatomical basis for transplantation of superior clunial fascio-cutaneous flap pedicled with cutaneous nerve and nutrient vessel and its accurate design of rotating point by applied anatomical analysis. DESIGN, TIME AND SETTING: An applied anatomical experiment was performed at Department of Anatomy in Dalian Medical University and Department of Anatomy in Medical College of Dalian University from March to May 2006. MATERIALS: Thirty-one sides of Chinese adult buttock specimens, perfused with red latex and fixed by formaldehyde, were selected in this experiment. METHODS: The superficial branches of the superior gluteal arteries were dissociated and their external diameters were measured. The superior cluneal nerves and the posterior branches of the fourth lumbar artery were dissected and the locations where they drilled through the deep fascia were recorded. The length of the intermediate branches of superior cluneal nerves and the external diameter of the posterior branches of the fourth lumbar arteries were measured. MAIN OUTCOME MEASURE: The anatomical data of superior cluneal fascio-cutaneous flap pedicled with cutaneous nerve and nutrient vessel were observed. RESULTS: The length of the intermediate branches of superior cluneal nerves (n=31) was (15.1±1.4) cm. The effective length of the area dominated by the intermediate branches of superior cluneal nerves (n=31) was (13.3±1.5) cm. Distance from the point where the superior clunial nerves and the posterior branch of the fourth lumbar artery drilled through the deep fascia to the upper margin of the iliac crest was (8.5±1.1) mm. Distance from the points (n=31) where the superior clunial nerves and the posterior branch of the fourth lumbar arteries drilled through the deep fascia to posterior median line was (7.1±1.6) cm. The external diameter of the posterior branches of the fourth lumbar arteries (n=31) was (1.0±0.3) mm. The external diameter of the first superficial branches of superior gluteal arteries (n=15) was (0.52±0.22) mm and that of the second (n=10) was (0.42±0.18) mm. CONCLUSION: The designed rotation point of superior cluneal fascio-cutaneous flap pedicled with cutaneous nerve and nutrient vessel was located at the point of (7.1±1.6) cm from posterior median line and (8.5±1.1) mm from the upper margin of the iliac crest. The length of the flap was (13.3±1.5) cm, and the width of the flap pedicel was 3.5 cm.