阴股沟皮瓣的显微解剖研究

APPLIED MICROANATOMIC STUDY OF PUDENDAL-THIGH SKIN FLAP

目的明确阴股沟皮瓣的解剖基础,为临床设计和应用提供解剖依据。方法对成年尸体11具(22侧)阴股沟区进行显微解剖研究。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;然后进行深部组织解剖,追溯血管、神经来源,并做记录。结果阴股沟区动脉血液供应充足,静脉回流丰富,神经支配可靠。阴部外浅动脉起始点主干直径为2.14±0.23mm,又分为升支(阴部外浅动脉腹股沟支,血管直径为1.38±0.34mm)、降支(阴部外浅动脉会阴支,血管直径为1.21±0.24mm)。阴囊(唇)后动脉主干(血管外径为1.13±0.24mm)和外侧支(血管直径为0.67±0.33mm)。闭孔动脉前皮支(血管外径1.68±0.11mm)。并且位置比较恒定,其中以阴部外浅动脉和阴囊(唇)后动脉最为恒定;三组血管网贯穿了皮瓣的上、中、下部。神经支配主要有生殖股神经股支,髂腹股沟神经皮支,阴囊(唇)后神经三组。结论阴股沟皮瓣血运丰富,解剖简便易行,切取方便,供区隐蔽,再造性器官外形及神经感觉均较理想。

Objective To investigate the microanatomic basis of the pudendal-thigh flap and provide the anatomic basis for clinical application. Methods Skin microdissection of the pudendal regions was performed on 11 adult cadavers （22 sides）. Then, the clinical way was simulated to obtain the flaps, and the vessels and nerves contained in them were surveyed. After that, the tissues in the deep part were dissected, and the vessels and nerves were traced back to their origins. The notes were taken. Results The blood supply to the pudenal regions was plentiful and constant. The initiation point of the superficial external pudendal artery was 2.14± 0. 23 mm in diameter; one branch of it was the inguinal branch and the other branch was the perineal branch. Their diameters were 1. 38 ± 0. 34 mm and 1.21±0.24 ram. The initiation point of the posterior labial or scrotum arteries was 1.13±0. 24 mm in diameter, and the lateral branch was 0. 67±0.33 mm in diameter. The anterior cutaneous branch of the obturator artery was 1.68± 0. 11 mm in diameter. The position of all the blood vessels was relatively constant, especially the external pudendal artery and the lateral branch of the posterior scrotal artery. Many of the blood vessels passed through the areas of the pudendum and the thigh, anastomosed with each other. Three groups of the vascular net passed through the upper, middle and lower parts of the flap. Three main groups of the innervation were as the following： the ramus femoralis nervi genitofemoralis, the cutaneous branches of the ilioinguinal nerve, and the post-nerve of the scrotum or the labia vulvae. Conclusion The pudendal-thigh flap has an abundant blood supply, and its dissection is convenient with an easy incision; the donor site is covert. The pudendal-thigh skin flap has the following advantages for the sexual organ reconstruction： the skin flap can have a good sensation and a good shape, and the operative procedure is easy to perform.