旋股外侧动脉降支分叶肌皮瓣的设计与临床应用

The design and clinical application of ramified musculocutaneous flap pedicled with the descending branch of lateral circumflex femoral artery

目的 设计旋股外侧动脉降支为蒂的分叶肌皮瓣，探讨分叶肌皮瓣的概念和临床应用效果。方法 通过解剖学研究，设计旋股外侧动脉降支为蒂，其支配的股外侧肌肌支形成肌瓣，肌皮支形成皮瓣的分叶肌皮瓣，临床用于治疗伴有软组织缺损的肢体骨髓炎和面部肿瘤切除与修复8例。结果 旋股外侧动脉降支在股骨中段有肌皮支2支以上，平均2．5支，可形成皮瓣；在股外侧肌的上中1／3入肌处发出向外的粗大肌支，降支主干在股外侧肌中段肌内行走的全程发出5～10支口径为0．4—1．4mm的肌支，均可用以形成肌瓣。可以用血管支的距离调整肌瓣和肌皮瓣的叶间距离，以提供叶间距合适的分叶肌皮瓣。8例肌皮瓣全部成活，2例后期行植骨术，随访6～20个月无再感染。结论 旋股外侧动脉降支可以形成股外侧肌和股前外侧皮瓣的分叶肌皮瓣。该肌皮瓣具有血管蒂长，叶间距大，腔隙填充完全，应用灵活，抗感染力强等优点。

Objective To design ramified musculocutaneous flap pedicled with the descending branch of lateral circumflex femoral artery and explore the concept and clinical effectiveness of ramified museuloeutaneous flap. Methods According to the anatomic study, the muscle flap blooded with the muscular branch of lateral femoral muscle and museuloeutaneous flap blooded with the museuloeutaneous branch were designed. All of which were pedieled with the descending branch of lateral circumflex femoral artery. In clinic, 8 cases were treated with this kind of ramified museulocutaneous flap because of osteomyelitis with soft tissue defects in extremities and tumor excision on face. Results Two and more branches （ average 2.5 branches） of the descending branch of lateral circumflex femoral artery in the middle of the shaft of femur could be made into skin slaps. The bigger muscular branch in the upper one-third of lateral femoral muscle and 5 - 10 muscular branches whose diameter ranges from 0. 4mm to 1.4mm in the middle of lateral femoral muscle could also be made into muscular flaps. The distance between muscular flap and museuloeutaneous flap could be adjusted by the distance of blood vessel branch. Eight cases were survivals. Two of them were treated with bone grafting in the later stage. For 6 - 20 months follow-up, infection didn＇ t recur. Conclusion The descending branch of lateral circumflex femoral artery can be made into rammified museuloeutaneous flap which includes muscular flap of the lateral femoral muscle and anterolateral thigh skin flap. This kind of ramified museuloeutaneous flap has such advantages as longer blood vessel pediele, longer distance of inter-flaps, filling the defects completely, flexible application and stronger anti-infection.