多血管神经蒂腹内斜肌瓣修复面瘫的解剖学基础

目的：为多血管神经蒂腹内斜肌瓣修复晚期面瘫提供解剖学基础。方法：在３６侧成尸标本上，对腹内斜肌的形态、血供及神经支配进行解剖观测。结果：腹内斜肌中部上１／２肌腹主要由第１１肋间神经支配，下１／２肌腹主要由肋下神经支配。上１／２肌腹的血供６６．７％来自第１１肋间后动脉，３３．３％来自旋髂深动脉的髂嵴支；下１／２肌腹的血供主要来自旋髂深动脉的腹壁肌支。第１１肋间神经、肋下神经在腋后线横径分别为２．２ｍｍ和２．４ｍｍ，入肌点距腋后线长分别为１３．３ｃｍ和１３．８ｃｍ。第１１肋间后动脉在腋后线外径为１．７ｍｍ，入肌点距腋后线长为１３．１ｃｍ；旋髂深动脉腹壁肌支和髂嵴支的起始外径分别为１．３ｍｍ和１．８ｍｍ，入肌点至起点长分别为５．１ｃｍ和８．６ｃｍ。结论：吻合多血管神经腹内斜肌瓣移植可全面修复晚期面瘫

Anatomical basis of free flap transfer of internal oblique muscle of abdomen in facial palsy treatment

Objective: To provide anatomical basis for the treatment of late facial palsy with free flap of internal oblique muscle of abdomen. Methods: The shape, blood supply and nerve innervation of the internal oblique muscle of abdomen were observed on 18 adult cadavers. Results:The internal oblique muscle of abdomen is a flat muscle, which is supplied by nerves and vessels.The upper 1/2 of muscle belly was innervated by the 11th intercostal nerves mainly, and nourished by the 11th posterior intercostal artery (66.7%) or the iliac branch of deep iliac circumflex artery (33.3%). The lower 1/2 was innervated by the subcostal nerve, and was nourished by the ascending branch of deep iliac circumflex artery. The diameters of the 11th intercostal nerves and subcostal nerves were 2.2 mm and 2.4 mm at posterior axillary line with the length from the muscle inlet to posterior axillary line 13.3 cm and 13.8 cm respectively.The 11th posterior intercostal artery was 1.7 mm in diameter at posterior axillary line.The diameters of ascending and iliac branches of deep iliac circumflex artery were 1.3 mm and 18 mm in their original parts and the lengths from the muscle inlets to their initial points were 5.1 cm and 8.6 cm respectively.Conclusions: Late facial palsy can be cured with neurovascularized free internal oblique muscle flap of abdomen.