阴股沟皮瓣的解剖基础及其在男性会阴部修复重建中的应用?

目的:为临床设计和应用阴股沟皮瓣提供解剖依据和手术方法.方法:解剖15具成年男尸阴股沟区.在尸体标本上,模拟临床皮瓣切取方式,对皮瓣内包含的血管、神经进行观测.依据解剖结果为患者合理设计皮瓣.手术时按设计分离出事先确定的轴心动脉,血管蒂周围组织应适当保留,将皮瓣转移至受区.供区创面直接拉拢缝合,对不能直接拉拢缝合的创面予以植皮处理.结果:阴股沟区动脉血液供应充足,静脉回流丰富,有固定的神经支配.该区的动脉血供有阴部外浅动脉、闭孔动脉前皮支、阴囊后动脉的主干和外侧支,并且位置均比较恒定,其中尤其以阴部外浅动脉和阴囊后动脉最为恒定.3组血管网贯穿了皮瓣的上、中、下部.神经支配主要有4组.临床应用阴股沟皮瓣23例,皮瓣切取最大为17 cm×9 cm,最小8 cm×5 cm,均取得理想的治疗效果.结论:阴股沟皮瓣血运丰富,切取方便,供区隐蔽,修复、重建男性会阴部外形及神经感觉均取得理想疗效,是一种值得推广的方法.

Pudendal-thigh flap: anatomic basis and application in repair and reconstruction of male perineal region?

Objective:To investigate the anatomic characteristics of the pudendal-thigh flap and provide anatomic basis for clinical design and application. Methods: The perineal regions of 15 male cadavers were anatomized. The flap was designed on the cadavers and the blood vessels/nerves contained in the flap were studied. Based on the above anatomic findings, we designed the flaps in our operation. The axial arteries were isolated according to the designing and the tissue adjacent to the vessel pedicles was preserved. The flaps were transferred to the recipient site. The incision of donor site was directly sutured; skin graft was transplanted when the incision could not be directly sutured. Results: The perineal regions had rich and constant blood supply and had stable nerve innervation. The blood supplies of the perineal region included external pudendal artery, anterior cutaneous branches of obturator artery, lateral branch of posterior labial or scrotum arteries. The location of the above vessels was comparatively constant, especially external pudendal arteries and posterior scrotum arteries. Three groups of blood vessels went through the lower, middle and upper parts, and there were 4 groups of major nerves responsible for the innervation of the pudendal region. We have used 23 cases of pudenal-thigh flaps, with the largest flap being 17 cm X 9 cm and the smallest being 8 cm X 5 cm, and satisfactory outcomes were achieved in all the cases. Conclusion: The pudenal thigh flap has rich blood supply, convenient incision, and covert donor site. It has satisfactory outcome (morphologic and sensory) in repairing and reconstructing male perineal region and is worth popularizing.