旋髂浅动脉穿支皮瓣的临床解剖学研究及其在舌癌缺损修复中的应用

Anatomy of superficial circumflex iliac artery perforator flap and its clinical application in tongue reconstruction

目的：探讨旋髂浅动脉穿支皮瓣的解剖学特点及其在舌癌术后修复中的应用。方法：2014年1 月至2015年1 月，解剖制备15例旋髂浅动脉穿支皮瓣，成功修复9 例舌癌根治术后缺损，术前及术后3 个月评价舌部功能及供区状况。结果：切取旋髂浅动脉穿支皮瓣面积27～110 cm2，平均厚度为（1.2 ± 0.3）cm，旋髂浅动脉从股动脉起始处的平均管径为（0.7 ± 0.2）cm，旋髂浅静脉为（1.2 ± 0.2）cm。旋髂浅动脉与旋髂深动脉和腹壁浅动脉的关系可以分为5 型：Ⅰ型（8/ 15），Ⅱ型（2/ 15），Ⅲ型（2/ 15），Ⅳ型（2/ 15），Ⅴ型（1/ 15）。 术后随访4～16个月，受区局部外形丰满，语言及吞咽功能恢复满意。供区均拉拢缝合，瘢痕隐蔽，无功能障碍。结论：旋髂浅动脉穿支皮瓣质地柔软，穿支血管蒂较长，供区瘢痕隐蔽，术后患者语音及咀嚼功能恢复良好，是修复舌癌术后缺损的良好选择。

Objective： To assess the anatomy of superficial circumflex iliac artery perforator （SCIP） and its feasibility for tongue reconstruction after tumor resection. Methods： From January 2014 to January 2015, a total of 15 patients with oral maxillofacial defects underwent SOP flap surgery. Perforator identification and SCIA course were performed intra-operatively. The relationships among the SCIA, deep circumflex iliac artery （DCIA）, and superficial inferior epigastric artery （SIEA） were determined intra-operatively. Surgical procedures, measurement of vessel＇s caliber and pedicle＇s length, SCIP flap anatomy, and their outcomes were described. Results： Flap mean thickness was approximately 1.2±0.3 cm. The mean diameter of the SCIA was 0.74±0.2 cm, and that of the superficial circumflex iliac vein was 1.24±0.2 cm. The relationships among SCIA, DCIA, and SIEA were described and subdivided into type I （8/15）, type II （2/15）, type III （2/15）, type IV （2/15）, and type V （1/15） in intra-operative dissection. The flap sizes were in the range from 6 cm × 4.5 cm to 11 cm × 10 cm. A total of 14 SCIP flaps survived, and 1 SCIP flap underwent necrosis. Conclusion： The SCIP flap is a reliable, thin, and pliable flap with long vascular pedicles and hidden donor site morbidity. Its texture is a perfect match for tongue defect reconstruction.