股后皮神经营养血管筋膜皮瓣的应用解剖

Applied anatomy of the vascular fasciocutaneous flap in the posterior cutaneous nerve of thigh

目的 :为股后皮神经营养血管筋膜皮瓣提供临床应用基础。方法 :用乳胶灌注成人尸体 34侧下肢并解剖 ,对股后皮神经及血管进行详细的应用解剖学观测。结果 :股后皮神经在距离坐骨结节 (7.4± 1 .0 ) cm处的臀大肌下缘离开臀部进入股后区 ,沿深筋膜深面下行至月国窝上角附近分为若干终支 ,干长为 (2 2 .5± 2 .8) cm,沿途分支至股后区皮肤 ,下达月国窝横纹附近。其横径在臀大肌下缘、神经干的上中 1 / 3交点及中下 1 / 3交点分别为 (4.4± 0 .8) mm、(3.4± 0 .7) mm、(2 .2± 0 .8) mm。股后皮神经的血供为多源性 ,臀下动脉、月国动脉及股深动脉第四穿动脉组成轴型血管 ,股深动脉穿支作为节段性动脉。两组动脉沿神经干互相吻合成网 ,并与皮下及深筋膜下的血管网相交通。结论

Objective: To provide the clinical applied basis for the vascular fasciocutaneous flap in the posterior cutaneous nerve of thigh. Method: Morphology of posterior cutaneous nerve of thigh and its blood vessels were minutely observed from 34 sides of adult lower limb cadaver injected with emulsion. Results: The posterior cutaneous nerve of thigh left gluteal area on the inferior margin of gluteus maximus,keeping ischial tuberosity distance from (7.4±1.0)cm and went along deep fascial profundal to popliteal fossa, and it was divided into several end branch in the popliteal fossa and dominated thigh skin. The length of nervous trunk was (22.5±2.8)cm. The width of the posterior cutaneous nerve of thigh on the inferior margin of gluteus maximus was (4.4±0.8)mm,(3.4±0.7)mm between 1/3 superior and middle trunk,and(2.2±0.8)mm between 1/3 inferior and middle trunk, respectively. The blood supply of the posterior cutaneous nerve of thigh was very profuse. Inferior gluteal artery,popliteal artery and the fourth penetrating artery of the deep femoral artery composed of the axis type vessel .The penetrating branch of the deep femoral artery was segmental artery. Two cases of arteries were anastomosed each other into vascular network, which communicated with cutaneous vessel and deep fascial vascular network. Conclusion: The anterograde or reverse flap with the pedicle of nutritional arteries of the posterior cutaneous nerve of thigh could repaire on limbs wound and soft tissues defeat after the excision of the skins tumor.