股深动脉穿支供血的横半月形股薄肌肌皮瓣的解剖研究及在乳房再造中的应用

Clinical anatomy of the transverse upper gracilis(TUG)flap supplied by branch of the profunda femoris artery in the field of breast reconstruction

目的为股深动脉穿支供血的横半月形股薄肌肌皮瓣在乳房再造中的应用提供解剖学依据，并探讨将其做成穿支皮瓣的可能性及大隐静脉属支在该皮瓣的分布规律。方法在4例8侧灌注红色乳胶的成人尸体下肢标本上对股薄肌上股深动脉穿支的出现率及其在股薄肌内的走行、血管外径、血管蒂长度以及伴随静脉和神经情况等进行解剖学观测。结果股深动脉股薄肌支在股薄肌肌皮瓣中的出现率为100％，其中75％来自于股深动脉，25％来自于旋股内侧动脉。穿支入肌点距股薄肌起点为（13．21±1．03）em，入肌处动脉外径（1．35±0．30）mm，沿途发出2～3只皮支，血管蒂动脉起点外径（2．77±0．54）mm，蒂长为（74．14±9．42）mm。伴随静脉终点外径（2．83±0．63）mm，大隐静脉属支在皮瓣范围内出现率87．5％，除1例无大隐静脉属支分布外，其余7例标本均有1支属支，外径为（2．60±0．64）mm。闭孔神经外径（1．85±0．53）mm。结论①股深动脉穿支在股薄肌中上1／3处出现率高，分布具有规律性，可以作为乳房再造的可靠供区；②皮瓣范围内存在较为恒定的大隐静脉的属支，可以作为皮瓣的第二套静脉系统予以保留以获得更好的静脉回流；③存在将横半月形股薄肌肌皮瓣做成穿支皮瓣的可能，在适合的病例中可以考虑减少肌肉的携带量以减少供区损伤；④股深动脉穿支供血的横半月形股薄肌肌皮瓣经标本手术模拟，证明切实可行；⑤供区关闭后切口瘢痕隐蔽，患者更易于接受；⑥根据胸部乳腺切除后缺损大小设计皮瓣，皮瓣宽度以供区能直接拉拢关闭为准，不仅可用于整个乳房的再造，而且适合于保乳术后乳房局部缺损的修复，对于双侧缺损的患者可以提供双侧皮瓣作为供区。

Objective To provide anatomic basis for the clinical application of the transverse upper gracilis flap sup- plied by profunda femoris artery in breast reconstruction. Method In 8 adult cadaver lower extremities injected with red latex, we observed the presence rate, route, outer diameter and pedicle length of the branch of the profunda femoris artery. The accompanying vein and nerve were also examined. Result The presence rate of artery supplied TUG flap was 100% ,in which 75% were from profunda femoris artery, and 25% from medial femoral circumflex artery. The pedicle entered the gracilis （ 13.21± 1.03） cm below the start of gracilis with outer diameter being （ 1.35 ±0. 30） ram, giving off2 -3 cuta- neous branches alongside. The pedicle length was （74. 14±9.42） mm with outer diameter being （2.77 ± 0. 54） mm, and （2. 83 ± 0. 63 ） mm for the accompanying vein. In our study, the presence rate of the great saphenous vein branches was 87.5%, only one specimen had no branch, all the others had one with the outer diameter of （2. 60±0. 64） mm. The di- ameter of obturator nerve was （ 1.85±0. 53 ） mm. Conclusion （1）The profunda femoris artery branch had a high presence rate in upper 1/3 of gracilis, thus the transverse upper gracilis flap is a reliable donor site for breast reconstruction. （2）There were relatively constant great saphenous vein branch, which could be reserved for better venous return. （3）It was possible to make a perforator flap in some cases to avoid unnecessary muscle damage. （4）The feasibility of the transverse upper gracilis flap supplied by branch of the profunda femoris artery was demonstrated by the modeling operation on the ca- daver. （5）The incision was subterranean and more acceptable by patients. （6）The flap was designed on the basis of the de- fect size during mastectomy, for readily closing without tension, and it can be used not only on the whole breast reconstruc- tion, hut also on the local damage after breast-conserving surgery, furthermore, it can provide two flaps to repair bilateral breast coloboma.