阴股沟皮瓣的解剖及其在男性会阴部修复重建中的应用

Pudendal-thigh flap:anatomic basis and application in repairing and reconstructing male perineal region

目的明确阴股沟皮瓣解剖基础,为临床设计和应用此皮瓣提供解剖依据和手术方法。方法解剖研究15具成年男尸阴股沟区的血供和神经支配情况。依据研究结果为男性会阴部修复重建患者设计合理的皮瓣。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。该区的动脉血供有阴部外浅动脉、闭孔动脉前皮支、阴囊后动脉的主干和外侧支,并且位置均比较恒定。三组血管网贯穿了皮瓣的上、中、下部。临床应用阴股沟皮瓣23例,皮瓣切取最大为17 cm×9 cm,最小8 cm×5 cm,均取得理想的治疗效果。结论阴股沟皮瓣血运丰富,切取方便,供区隐蔽,在修复、重建男性会阴部时,可以取上、中、下蒂皮瓣。术后皮瓣成活率高,外形及神经感觉均取得理想结果。

Objective To investigate the anatomic feature of pudendal-thigh flap and to provide anatomic guide for clinical design and application of the flap in repairing and reconstructing male perineal region. Methods The clinical anatomy of blood supply and refluence and nerve innervation of the perineal region in 15 male cadavers （30 sides） were investigated. Then reasonable flaps were designed for male patients needing repair and reconstruction of the perineal regions based on the anatomic finding. Results Perineal region has adequate arterial blood supply, abundant venous refluence and reliable nerve innervation. The area has multi-source blood supplies： external pudendal artery, anterior cutaneous branches of obturator artery, bole and lateral branch of arteriae scrotales posteriores. The locations of the arteries were mainly uniform in the 30 sides. Three vasoganglion composed by these arteries and their branches connecting superior, central and inferior parts of the flap. In the 23 cases, the largest flap was 17 cm×9 cm, and the smallest was 8 cm × 5 cm. The flaps survived and recovered well, with perfect appearance and sensation. The patients were all satisfied with the operation results. Conclusions The pudendal-thigh flap has abundant blood supply. It can be incised conveniently and covers donor sites well. The flap can be used to repair and reconstruct male perineum with ideal appearance and sensation.