会阴穿支皮瓣的显微解剖研究和临床应用初步报告

Primary report on microdissection Study of perineum perforating flap

目的本研究旨在通过对会阴区域的穿支血管定性和定量分析,即确定主要穿支血管的位置、数量、口径、蒂的长度类型、来源血管以及穿支所供应皮肤的面积,着重研究穿支皮瓣的血管解剖基础,为临床设计应用穿支皮瓣提供解剖学依据。方法选用经10%甲醛溶液固定、红色乳胶经桡动脉及髂外动脉联合灌注的成年尸体11具(22侧)。肉眼解剖,微细结构在10倍手术放大镜下观察,用游标卡尺(精确到0.2mm)测量。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。结果我们发现该区直接与间接穿支血液供应丰富,其中以阴部外浅动脉腹股沟和会阴穿支、阴囊(唇)后动脉外侧穿支、闭孔动脉前皮支穿支四支最具临床意义,并且位置均比较恒定,分别位于皮瓣上、中、下方。上述四支穿支以及它们的伴行静脉彼此存在广泛的吻合,并在内收肌内侧以上的深筋膜层上方形成会阴区上方、中间、下方三组链式血管吻合网。另外还有分布于皮瓣上、中、下的四支重要的皮神经:生殖股神经股皮支、髂腹股沟神经皮支、阴囊(唇)后神经皮支、股后皮神经会阴支皮。结论会阴穿支皮瓣血供充足,静脉回流丰富、又具有神经支配及淋巴回流系统。切取方便,供区隐蔽,修复、重建会阴部外形及神经感觉均可以取得理想结果,是一种值得推广的方法。

Objective The aim of study is to determine position, quantity, caliber, peduncular length, original vessels, and supply dermatic area of the main perforating branch by perineal region＇ s vessel qualitation and quantitative assay, especially in vessel anatomic basic of perforating branch flap, and provide evidence for application of perforating branch flap. Method Eleven （22 sides） adult corpses having been soaked in 10% formalin were selected, which were infused red emuls through arteria radialis and external ili- ac artery,and surveyed vessels and nerves by 10 times operating loupe and sliding caliper. Results The di- rect and indirect perforating branch blood supply of perineal region was found plentiful and constant. Moreo- ver, the position of all vessels was relatively constant, especially the superficial external artery fold inguen and perineal perforating branch, the lateral arteriae scrotales （labiales） posteriors perforating branch, arteria obturateria anterior cutaneous perforating branch. The position of all these branches was found constant, lo- cated in upper, middle, below of the flap. All these perforating branches and their accompanying veins coin- cided with each other, and formed upper, middle, below chain rete vasculosum in deep fascia above adduc- tor wall. There were other four important cutaneous nerves： ramus femoralis nervi genitofemoralis thigh cuta- neous branch, cutaneous branches of ilioinguinal nerve, posterior scrotum or labium majus nerves cutaneous branch, rami perineales nervi cutanei femoris posterioris cutaneous branch. Conclusions The perineum perforating flap has abundant blood supply, with venous return plentiful, and innervations lymphatic return sufficient, convenient dissection, easy incision, covert donor site. The method of sexual organ reconstruction using the pudendal thigh skin flap has many advantages： the skin flap gives good sensation and shape, and the procedure is easy for application.