股上部直接皮动脉皮瓣的临床研究

目的 探讨切取股上部直接皮动脉皮瓣的解剖学依据并回顾其临床疗效.方法 对20侧灌注红色乳胶成人尸体下肢标本,进行解剖学观察;对其中2侧新鲜下肢标本,予股上部直接皮动脉灌注中华墨汁,观察皮瓣墨染范围.在50例股前外侧皮瓣切取手术中,对发现的股上部直接皮动脉进行追踪解剖.观察股上部直接皮动脉的出现率、动脉起始来源、走行并测量其管径.临床对42例皮肤软组织缺损的患者.采用股上都直接皮动脉皮瓣移植修复.结果 20侧灌注红色乳胶成人下肢标本,股上部直接皮动脉血管出现率为75.0%(15侧,15条).其中2侧新鲜下肢标本,股上部直接皮动脉皮瓣墨染面积分别为11.0 cm×18.0 cm、11.0 cm×19.0 cm.观察50例股前外侧皮瓣切取手术中,股上部直接皮动脉出现率为72.0%(36例,36条).出现的这51条股上部直接皮动脉中,血管起源类型有三种:起源于旋股外侧动脉(共29条,占56.9%);起源于股深动脉(共8条,占15.7%);起源于股动脉(共14条,占27.4%).股上部皮支血管从起点发出后,向大腿外下方于深、浅筋膜之间走行人皮肤,其穿出点多位于髂前上棘-髌骨外上缘连线中点上方3.0 cm、外侧2.5cm范围内,行程(10.7±3.3)cm,(x)±s,下同].起始外径(2.7±0.2)mm,伴行静脉外径分别为(2.8±0.4)mm、(2.4±0.3)mm.本组42例股上部直接皮动脉皮瓣,皮瓣切取面积为6.0 cmx8.0cm～11.0cm×18.0 cm(游离皮瓣11例,带蒂皮瓣31例).术后3例皮瓣边缘部分坏死,经换药和皮片移植后愈合,其余皮瓣全部存活.结论 该皮瓣血供良好,不携带肌肉,切取容易,可携带股前外侧皮神经,既可带蒂转移,亦可作吻合血管的游离移植.

The clinical study of direct cutaneous artery flap of the upper thigh

Objective To study the anatomic basis of direct cutaneous artery flap of the upper thigh and review the clinical outcome of its application. Methods The direct cutaneous arteries of the upper thigh were dissected in 20 sides of the adult embalmed cadaverie specimens perfused with red relax. The arteries were perfused with Chinese ink in 2 fresh cadaver specimens to observe the distribution area. During surgical harvesting of anterolateral femoral skin flap in 50 cases, the occurrence rate, source artery, diameter and course of the direct cutaneous arteries of the upper thigh were noted. Forty-two cases of soft tissue defects were repaired with direct cutaneous artery skin flap of the upper thigh. Results Direct cutaneous arteries of the upper thigh oecurred in 15 of 20 sides of the adult embalmed cadaveric specimens perfused with red relax. The occurrence rate thereof was 75.0%. The size of the flaps dyed with Chinese ink was 11.0 cm × 18.0 cm. The occurrence rate of direct cutaneous arteries during dissection of the 50 cases of anterolateral femoral skin flap was 72.0% (36 arteries in 36 cases). Direct cutaneous artery of the upper thigh came from the lateral femoral circumflex artery ( 56.9%, 29 sides), the deep femoral artery( 15.7%, 8 sides) or the femoral artery ( 27.4%, 14 sides ). The mean diameter of origin site. of these direct cutaneous arteries was (2.7 ±0.2) mm. Among the 42 cases of direct cutaneous artery skin flap of the upper thigh, 3 flaps survived with partical necrosis and healed after changing dressing or skin graft. The others survived completely, the size of flaps ranged from 6.0 cm × 8.0 cm to 11.1cm×18.0cm(11 free skim flaps andm 31 pedicle flaPS), Conclusion The direct eutaneous artery skin flap of the upper thigh has good blood supply and is easy to harvest. It can be made into not only pedicled flap but also free transplantable flaps. It is possible to harvest the flap without any muscle. The lateral femoral cutaneous nerve can be harvested and anastomosed with a cutaneous nerve of the recopient site.