阴股沟岛状皮瓣阴道成形术的应用解剖及疗效评价

Applied anatomy and clinical evaluation of vaginal reconstru ction using the pudendal-thigh island flaps

目的 进一步明确阴股沟岛状皮瓣阴道成形术的应用解剖 ,综合评价该术式的治疗效果。方法 5具成年女尸 ,采用动脉灌注红色明胶观察 10侧阴股沟区血管构筑。随访采用阴股沟岛状皮瓣行阴道成形术后 3年以上且已婚者 2 0例。结果 阴股沟区血供来源于阴唇后动脉、阴部外动脉及闭孔动脉的前皮支 ;阴唇后动脉为阴部内动脉的分支之一 ,其起点外径为 0 .9～ 1.7mm(平均 1.3mm) ,距会阴中线 2 2～ 35mm(平均 2 6mm) ,血管走行于大阴唇外侧 ,可见伴行的静脉及神经 ,途中发出 4～ 7条分支分布于大阴唇及阴股区后 2 / 3段。 2 0例被访者对外阴形态满意 ,平均阴道深度为 10 .2cm ,可容纳两指 ,性生活满意。结论 阴股沟岛状皮瓣以阴唇后血管神经束为蒂 ,血运丰富 ,形成的阴道可以满足生理需求。

Objective To introduce the anatomic basis and evaluat ion of clinical application of the pudendal-thigh island flaps us ing for vaginal reconstruction. Methods The blood supply and innervation to the skin and fascia of the pudendal-thigh region were studied in 5 female cadavers (with 10 sides). 20 patients who underwent vaginal reconstruction with pudendal-thigh island flaps were followed-up, and all the women were married for more than 3 years. Results There were multiple blood supply in the pudendal-thigh area. The cuta neous arterial vessels come from the posterior labial artery, the external pudendal artery and the anterior cutaneous branches of obturator artery. The posterior labial artery was one of the internal pudendal artery branches, a nd the diameter of it was 0.9～1.7 mm (1.3mm in average) in its original site, w hich was 22～35 mm (26mm in average) from the perineal midline. It gave off 4 ～7 branches to the major labia and the pudendal-thigh area while running alon g the lateral site of the major labia accompanying vein and nerve. 20 patients w ho were followed-up satisfied with their perineal appearance and with 10. 2 cm depth of neovagina in average. Twenty neovagina remained supple, and sexually active without difficulty. Conclusions The pedicle of the pudendal-thigh island flaps using for vaginal reconstruction is the post erior labial neurovascular bundle. The flap has reliable blood supply, survive s easily, transfers with partial sensation and few complications. This tech nique introduces a modified approch of vaginal reconstruction using bilateral pudendal- thigh island flaps with satisfactory cosmetic and functional resu lts.