股前外侧穿支皮瓣的应用解剖研究及临床应用

中国口腔颌面外科杂志 ›› 2015, Vol. 13 ›› Issue (6): 502-507.

股前外侧穿支皮瓣的应用解剖研究及临床应用

徐镭，高鹏飞，徐万林，程杰，李怀奇，吴煜农，叶金海

南京医科大学口腔疾病研究江苏省重点实验室，南京医科大学附属口腔医院口腔颌面外科，江苏南京 210029

收稿日期:2015-08-12 出版日期:2015-11-20 发布日期:2015-12-03
通讯作者: 叶金海，E-mail: yjh98001@163.com
作者简介:徐镭（1991-），男，在读硕士研究生，E-mail:895935420@qq.com
基金资助:
Supported by National Natural Science Foundation of China (81371123) and Priority Academic Program Development of Jiangsu Higher Education Institutions.

Applied anatomic study and clinical application of anterolateral thigh perforator flap

XU Lei, GAO Peng-fei, XU Wan-Lin, CHENG Jie, LI Huai-qi, WU Yu-nong, YE Jin-hai.

Jiangsu Key Laboratory of Oral Diseases;Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University. Nanjing 210029, Jiangsu Province, China

Received:2015-08-12 Online:2015-11-20 Published:2015-12-03
Contact: 国家自然科学基金（81371123）；江苏高校优势学科建设工程资助项目（2014-37）

摘要/Abstract

摘要： 目的：通过对股前外侧穿支皮瓣的解剖学研究，探讨制备股前外侧穿支皮瓣的合理性及稳定性；并对临床上应用股前外侧穿支皮瓣的供区及受区的术后恢复情况等进行随访，评价其在口腔颌面部缺损修复重建中的应用价值。方法：选取6例中国成人下肢标本，解剖并记录股前外侧穿支的数目、分布、部分层面血管外径及各段血管长度；并选择9例采用股前外侧穿支皮瓣移植修复口腔颌面部缺损的病例，皮瓣面积5 cm×6 cm～6 cm×12 cm。术后随访观测皮瓣存活情况，评价受区臃肿度及供区功能恢复、术后吞咽及语言功能情况。结果：6例下肢标本共测量记录到股前外侧穿支21支，平均3.5支。大腿股前外侧穿支主要出现在髂前上棘至髌骨外侧缘连线中点外1 cm以下约2 cm为圆心、半径约6 cm的圆内，源动脉起始部外径平均为（2.99±0.48）mm，血管蒂总长度平均为（15.83±3.52）cm；9例股前外侧穿支皮瓣，1例发生部分组织坏死， 1例病例失访，术后随访10～47个月（平均24个月）。股前外侧穿支皮瓣存活率较高，供区并发症少，受区皮瓣臃肿程度低，吞咽功能恢复良好。结论：股前外侧穿支皮瓣穿支分布稳定，血管蒂较长，穿支的管径完全满足游离皮瓣的要求，临床应用中供区并发症少，受区不臃肿，组织量适中，结合其解剖稳定性，可满足临床修复口腔颌面部组织缺损的需要。

关键词: 穿支皮瓣, 应用解剖, 股前外侧穿支皮瓣

Abstract: PURPOSE : To provide anatomic evidence for clinical application of anterolateral thigh flap, this study compared the appearance and function of donor site and recipient site pre- and post-operatively in order to investigate the clinical value in reconstruction of oral and maxillofacial defects. METHODS : Six lower limbs of Chinese adult cadavers were microsurgically dissected and the number of perforators was recorded based on anterolateral thigh perforator flap, the external diameters, pedicle lengths, and locations were measured. Nine clinical cases of anterolateral thigh perforator flap were selected from May 2011 to May 2014, the flap size ranged from 5 cm×6 cm to 6 cm×12 cm. The patients were evaluated during postoperative follow-up including flap survival number, contour and function of recipient and donor site, and their swallowing and speech function after reconstruction of the tongue and/or floor of mouth. RESULTS : Totally 21 anterolateral thigh perforaters(each leg on average 3.5) were found in 6 legs. Nearly all perforaters of the anterolateral thigh were located in a 6 cm diameter circle, the center of the circle was located 1 cm horizontally and 2 cm vertically to the middle line between the anterior superior iliac spine and the patellar lateral edge. The external diameter of vessel pedicle was (2.99±0.48) mm and the pedicle length was (15.83±3.52)cm. Among the 9 anterolateral thigh perforator flaps, 1 flap had partial necrosis, 1 case was lost for follow up. All the cases were followed up for 10-47 months (mean 24 months). Anterolateral thigh flap was favourable in survival rate, donor or recipient site complications, swallowing and speech function. CONCLUSIONS : Anterolateral thigh flap has constant perforator, longer pedicle and suitable diameter. Clinically, anterolateral thigh flap has fewer complications, moderate size and pleasing contour, which satisfy the need for reconstruction of oral and maxillofacial defects.

Key words: Perforator flap, Applied anatomy, Anterolateral thigh perforator flap

中图分类号:

R782.2

徐镭，高鹏飞，徐万林，程杰，李怀奇，吴煜农，叶金海. 股前外侧穿支皮瓣的应用解剖研究及临床应用[J]. 中国口腔颌面外科杂志, 2015, 13(6): 502-507.

XU Lei, GAO Peng-fei, XU Wan-Lin, CHENG Jie, LI Huai-qi, WU Yu-nong, YE Jin-hai.. Applied anatomic study and clinical application of anterolateral thigh perforator flap[J]. China J Oral Maxillofac Surg, 2015, 13(6): 502-507.

参考文献

[1] Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle [J]. Br J Plast Surg, 1989, 42(6): 645-648.
[2] Hallock GG. Anatomic basis of the gastrocnemius perforator-based flap [J]. Ann Plast Surg, 2001, 47(5): 517-522.
[3] 徐达传, 钟世镇, 刘牧之, 等. 股前外侧穿支皮瓣的解剖学 [J]. 临床应用解剖学杂志, 1984, 2(3):158-160.
[4] Lalovi N, Cvijanovi R, Malis M, et al. Surgical anatomy of the initial segment of the lateral circumflex femoral artery [J]. Med Pregl, 2013, 66(7-8): 326-330.
[5] Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review [J]. Plast Reconstr Surg, 2012, 130(6): 1254-1268.
[6] Lee YC, Chen WC, Chou TM , et al. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications [J]. Plast Reconstr Surg, 2015,135(4): 1097-1107.
[7] 陈奇鸣, 杨福周, 罗景辉, 等. 股前外侧穿支皮瓣穿支血管变异形态及临床应用对策[J]. 中华整形外科杂志,2013,29(1):59-61.
[8] 单振锋, 周晓, 李赞, 等. 应用股前外侧游离组织瓣修复头颈部肿瘤术后缺损临床分析 [J]. 临床耳鼻咽喉头颈外科杂志, 2014, 28(21): 1685-1687.
[9] Gong ZJ, Wang K, Tan HY, et al. Application of thinned anterolateral thigh Flap for the reconstruction of head and neck defects [J]. J Oral Maxillofac Surg, 2015, 73(7): 1410-1419.
[10] Cigna E, Minni A, Barbaro M, et al. An experience on primary thinning and secondary debulking of anterolateral thigh flap in head and neck reconstruction [J]. Eur Rev Med Pharmacol Sci, 2012, 16(8): 1095-1101.
[11] Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap thinning: techniques and complications [J]. Ann Plast Surg, 2014, 72(2): 246-252.
[12] 刘杰, 张彬, 李德志, 等. 应用周边穿支皮瓣作为股前外侧皮瓣皮穿支血管缺失时的替代方案研究 [J].中华耳鼻咽喉头颈外科杂志, 2013, 48(6): 486-489.