阔筋膜张肌穿支皮瓣的局部解剖及其在头颈修复中的意义

Anatomy of tensor fascia latae perforator flap and its clinical significance in reconstruction of head and neck defects

目的探讨阔筋膜张肌穿支皮瓣的解剖学基础及其在头颈修复中的临床意义。方法(1)解剖新鲜成人尸体5具,观察、测量阔筋膜张肌穿支皮瓣供血穿支的数目、类型、管径、蒂长、走行、出筋膜后轴向及源血管外径,并对其定位。结果阔筋膜张肌穿支血管41支,平均每侧(4.1±1.3)支。其中肌皮穿支35支,肌间隔支/直接皮穿支6支。蒂血管动静脉外径分别为(3.01±0.49)mm和(3.28±0.57)mm。平均蒂长(9.10±0.79)cm。以髂前上棘为坐标,其垂直线为纵轴,其水平线为横轴,穿支血管定位:髂前上棘垂直线外(4.22±1.37)cm,水平线下(8.73±2.72)cm范围内。结论阔筋膜张肌穿支皮瓣的穿支血管解剖位置较为恒定,管径粗,穿支皮瓣制作方便,在头颈肿瘤术后缺损的修复中可作为股前外侧穿支皮瓣的备份皮瓣。蒂长常小于10 cm是其缺点。

Objective To study anatomy of the tensor fascia latae perforator flap （ TFLP flap） and explore its clinical application in reconstruction of head and neck defects. Methods Five fresh cadavers were prepared, and morphology and blood supply of TFLP flap were examined by microsurgery anatomy. During dissections, the following parameters were recorded ： number and type of perforators vessels, diameter of perforators, pedicle length, diameter of the original vessels, course（ infra fascia and supra fascia） ,and its position was located by anatomical landmark. Results There were 41 TFLP flap perforators in all specimen with 35 musculocutaneous perforator and 6 septocutaneous perforator. Original vessel was ascend branch of lateral circumflex femoral artery/vein with average diameter of （3.01±0.49）mm/（3.28 ±0. 57）mm. The mean pedicle length was （9. 1±0. 79）cm. The surface location was （4. 22 ± 1.37 ）cm laterally and （8.73 ± 2. 72）cm beneath to anterosuperior iliac spine. Conclusion With the characteristics of constant position, large caliber and convenient preparation, TFLP flap is useful for operation and option in reconstruction of head/neck defects and considered as backup of anterolateral thigh flap. The disadvantage of this flap is its short vascular pedicle.