股内侧皮瓣的改良设计和游离移植

Design improvement and free grafting of modified medial thigh flap

目的基于缝匠肌内外缘肌间隙皮穿支形成链式血管网的解剖学特点,探讨改良设计的股内侧皮瓣游离移植修复较大皮肤缺损的临床效果。方法以Doppler血流探测仪定位缝匠肌内外缘的动脉穿支,继以彩超辨识出其中最粗大者为蒂,以缝匠肌走行为轴心线设计股内侧皮瓣。2008年10月至2011年8月,切取改良股内侧皮瓣游离移植修复5例皮肤缺损。结果Doppler血流探测仪提示缝匠肌内外缘肌间隙均有5～8支穿支血管,彩超检查表明其中至少有1支内径大于1.5 mm,术中解剖发现其来源于股浅动脉或旋股外侧动脉降支。皮瓣游离移植后全部成活,皮瓣切取面积(12 cm×8 cm)～(22 cm×12 cm),供区大部分缺损直接拉拢缝合。随访5～25个月,皮瓣柔软、色泽良好,2例外形良好,3例外形较臃肿。结论改良股内侧皮瓣包含较多肌间隙穿支,可切取面积大,主要营养血管口径较粗,供区易于拉拢缝合,克服了血管变异、解剖困难等不足,是一种适用性较广的游离皮瓣。

Objective To evaluate the clinical efficacy of free grafting of modified medial thigh （MMT） flap for covering large skin defects, and the MMT flap was designed according to chain anastomosis between the septocutaneous perforators located on the medial and lateral spatium of sartorius muscle. Methods The perforators were localized along medial and lateral border of sartorius muscle with hand-held Dopplers, among them the stockiest one was identified as major pedicle using color Doppler ultrasound, the skin paddle of flaps were centered on the sartorius muscle trajectory. From October 2008 to August 2011, five patients with large wounds received free modified medial thigh flaps treatment. Results Five to eight perforators were found on both the inner and outer border of sartorius muscle, at least one pedicle was noted with a diameter greater than 1.5 mm by color ultrasound. The major perforators were further verified in the surgical dissection origina- ting from superficial femoral artery or descending branch of the lateral circumflex femoral artery. All five free flaps survived uneventfully, flap sizes ranged from （ 12 cm ×8 cm） to （22 cm× 12 cm） ,majority area of the donor sites were closed by direct approximation. The follow-up period continued from 5 to 25 months, all flaps sustained pliable and fair color, cosmetic contour achieved in two cases and some kind of bulkiness in three cases. Conclusion The free MMT flap comprises at least one large caliber pedicle and numerous perforators that nourishing broad skin territory, donor sites are easier to primary closure. Flap design is modified to enhance its reliability and versatility for reconstruction of large defect due to uncomplicated harvesting and fewer variations of the pedicle.