腓肠内侧动脉穿支皮瓣的应用解剖及临床研究

Applied anatomic study and clinical application of medial sural artery perforator flap

目的:通过对腓肠内侧动脉穿支皮瓣的解剖学研究,探讨制备腓肠内侧动脉穿支皮瓣的合理性及稳定性;并对临床上应用腓肠内侧动脉穿支皮瓣修复的患者的供区及受区术后恢复情况等进行随访,评价其在口腔颌面部缺损修复重建中的应用价值。方法:选取6例中国成人下肢标本,解剖并记录腓肠内侧动脉穿支的数目、分布、部分层面血管外径及各段血管长度;同时对16例口腔鳞癌术后缺损患者采用腓肠内侧动脉穿支皮瓣进行修复重建,皮瓣面积3 cm×4 cm～6 cm×8 cm。术后随访12个月,观察皮瓣存活情况,受区臃肿度,供区功能恢复,术后吞咽及语言功能情况。结果:6例下肢标本共测量记录到腓肠内侧动脉穿支14条,平均2.3条。小腿腓肠内侧动脉穿支平均距腘皱褶下缘(9.15±4.05)cm,距后正中线(2.82±0.91)cm,源动脉起始处外径平均为(2.11±0.17)mm。血管蒂总长度平均为(12.61±3.15)cm;16例腓肠内侧动脉穿支皮瓣,2例发生血管危象并部分坏死,2例失访(术后随访10～47个月,平均24个月)。2例皮瓣移植发生血管危象伴部分坏死病例未纳入随访。腓肠内侧动脉穿支皮瓣存活率较高,供区影响小,组织量适中,受区外形不臃肿,质地、弹性良好,吞咽、语言功能均无明显影响。结论:腓肠内侧动脉穿支皮瓣穿支数目及分布稳定,血管蒂长度及管径完全满足游离皮瓣移植要求,供区影响小,组织量适中,皮瓣受区不臃肿。结合其解剖稳定性,是口腔颌面部软组织中小型缺损修复重建的理想选择。

PURPOSES:To provid e anatomic evidence for clinical application of medial sural artery perforator flaps(MSAP),this study compared the contour and function of donor site and recipient site pre-and post-operatively in order to investigate the clinical value in reconstruction of oral and maxillofacial defects.METHODS:Six lower limbs of Chinese adult cadavers were micro-surgically dissected and the number of perforators was recorded based on medial sural artery perforator flaps,the external diameters,pedicle lengths,and locations were measured.Sixteen clinical cases using medial sural artery perforator flaps for reconstruction were selected from May 2011 to May 2014,the flap size ranged from 3 cm×4 cm to 6 cm×8 cm.The patients were evaluated at 3,6 and 12 months postoperatively including flap survival number,contour and function of recipient and donor site,and their swallowing and speech function after reconstruction of the tongue and/or floor of mouth.RESULTS:Totally 14 medial sural artery perforators(each leg had 2.3 on average) were found in 6 legs.The average longitudinal distance from the medial sural artery perforators to popliteal crease was(9.15 ±4.05) cm,and(2.82±0.91)cm to posterior midline of the leg.The external diameter of vessel pedicle was(2.11 ±0.17) mm,and the pedicle length was(12.61±3.15) cm.Among the 16 medial sural artery perforator flaps,two flap had venous crisis and eventually developed necrosis,two patients were lost to follow up.All the cases were followed up for 10-47 months(mean 24 months),two cases with flap necrosis were excluded.Medial sural artery perforator flap was favorable in donor site morbidity,swallowing and speech function.CONCLUSIONS:Medial sural artery perforator flap has a good anatomic stability,with vascular pedicle length and diameter completely meeting requirements of the clinic,which is an ideal choice to reconstruct small or medium-sized oral and maxillofacial defects.