以旋股外侧动脉降支为蒂分叶股前外侧肌皮瓣设计的解剖学研究

Anatomy of the lobulated anterolateral thigh myocutaneous flap pedicled with the descending branch of the lateral femoral circumflex artery

目的为以旋股外侧动脉降支为蒂的分叶股前外侧肌皮瓣的设计与临床应用提供解剖学基础。方法新鲜下肢标本20侧,动脉灌注红色乳胶,重点观察动脉进入股外侧肌的部位,及其在股外侧肌内的分支、分布与吻合情况。结果 (1)80.8%的降支发自旋股外侧动脉,外径(3.7±0.9)mm,于股直肌深面,沿股外侧肌前缘下降,在起始下方(9.0±3.5)cm处分为内、外两侧支。(2)外侧支营养股外侧肌,肌外血管蒂长(8.1±3.3)cm,在股外侧肌中段肌内行走的全程发出6.6支口径1.0mm的肌支或肌皮支,平均支间距(1.9±0.9)cm。(3)股前外侧部出现皮支(2.5±1.2)支,外径(0.8±0.3)mm,其中肌间隙穿支占23.8%,而肌皮穿支占76.2%。57.7%(15侧)肢体有高位皮动脉出现。结论 (1)可以设计以旋股外侧动脉降支为蒂的分叶股前外侧肌皮瓣,并用不同部位的血管支的距离来调整肌瓣和肌皮瓣的叶间距离,修复不同的创面。(2)以旋股外侧动脉降支为蒂的分叶股前外侧肌皮瓣是临床修复复杂创面的一种极佳选择。

Objective To provide anatomical basis for the design and application of the lobulated anterolateral thigh myocutaneous flap pedicled with the descending branches of the lateral femoral circumflex artery.Methods 20 fresh lower extremities,with artery injecting of red lactoprene,were used in this study.The entry sites of the descending branches into the vastus lateralis muscle,and the branches,distribution and the anastomosis of vessels in the muscle were explored.Results（1） Descending branches mainly（80.8%） came from the lateral femoral circumflex artery,with the average external diameter of（3.7±0.9） mm.the artery laid deep the rectus femoris muscle,and ran downwards along the anterior border of the vastus lateralis muscle,and branched into medial and lateral branches under the starting point about（9.0±3.5）cm.（2）The lateral branches,with the average length of the vascular pedicle of（8.1±3.3）cm,supplied the vastus lateralis muscle,which gave off 6.7 branches averagely to the vastus lateralis muscles and the skin of the anterolateral thigh.The average diameter of it was about 1.0mm,and the distance between the neighboring branches was about（1.9±0.9） cm.（3） There were（2.5±1.2） cutaneous branches appeared in the anterolateral thigh area with the diameter of（0.8±0.3） mm,and in these branches,23.8% were spatium intermusculare perforators and 76.2% musculo-cutaneous perforators.High cutaneous artery branches were found in 15 cases（57.7 %）.Conclusions（1） Utilizing the different branches,the lobulated anterolateral thigh myocutaneous flap can be designed,and the space between the flaps can be adjusted according to the shape and the location of the recipient site.（2）The lobulated anterolateral thigh myocutaneous flap pedicled with the descending branch of the lateral femoral circumflex artery is an ideal selection to restore the complex wounds.