按Angiosomes原理设计股前外侧复合组织瓣

Design of Anterolateral Thigh Composite Flap on the Angiosome Principle

目的详细了解股前外侧复合组织瓣(包括皮肤、皮下组织、肌肉和带骨膜的骨块)三维血管解剖分布,并分析应用此复合组织瓣修复伴骨缺损足踝部创面的治疗效果。方法在10例新鲜尸体和10例福尔马林尸体中的40例成人双侧股动脉内灌注改良氧化铅-明胶混合液,详细解剖以旋股外侧血管为蒂的股前外侧游离复合组织瓣,获得此血管在皮肤、皮下组织、肌肉和骨的分布数据。在传统股前外侧皮瓣手术方法的基础上,切取此皮瓣时凿取旋股外侧血管横支或降支支配的骨膜和骨,修复伴骨缺损足踝部创面。结果本组40例股外侧肌标本均属Ⅱ型,即接1个优势血管和2～3个次要血管。其中优势动脉蒂来自旋股外侧动脉横支和降支,横支供应肌肉的上1/3部分,降支节段性地发出4～10个分支,供应肌肉下1/2的内侧部分,同时也发出3～5个肌皮穿支,供应肌肉表面的皮肤。肌肉下2/3的后侧部分则由起自股深动脉的第2～3穿动脉供应。优势动脉和次要动脉之间存在广泛的血管吻合。旋股外侧血管横支及降支均发出骨膜支,分布于股骨骨膜上。应用此复合组织瓣修复的6例足踝部骨缺损,随访6～12个月,复合组织瓣弹性良好,耐磨性好。术后3个月X线摄片显示,骨质缺损处已愈合。结论旋股外侧血管分布情况为临床切取此复合组织瓣提供指导。旋股外侧血管横支及降支有骨膜?

To investigate the three-dimensional vasculature of the anterolateral thigh composite flap and to determine its efficacy in the reconstruction of foot injuries with bone defect.Methods Ten fresh cadaver specimens and ten formalin-kept cadaver specimens were examined after infusion with a radio-opaque lead oxide mixture.The vascular anatomy of the lateral circumflex femoral artery to the skin,the muscles,and the periosteum of the bone of the thigh were studied.The anterolateral thigh composite flap based on the lateral circumflex femoral artery was used for foot reconstruction in 6 cases.Results The uppermost portion of the vastus lateralis muscle was supplied by 1 or 2 branches of the transverse branch of the lateral circumflex femoral artery.The descending branch of the lateral circumflex femoral artery entered the vastus lateralis 8～18 cm below its origin.It descended vertically,sometimes,along the anterior edge of the vastus lateralis,and gave off 5～10 branches which ran at an inferolateral direction into the muscle. Meanwhile,it gave off 3～5 musculocutaneous or septocutaneous perforators to the overlying skin.The transverse branch and the descending branch of the lateral circumflex femoral artery also sent the branches to the periosteum of femoral bone. The posterior portion of the muscle received three perforating arteries from the profunda femoral artery.Fine vascular communication was found between the territories of the descending branch of the lateral circumflex femoral artery and the perforating arteries of the profunda femoral artery.All six anterolateral thigh composite flaps survived.Conclusion This anatomical study provides further information to design or redesign the anterolateral thigh composite flap,especially when composite tissues are included in the flap.The anterolateral thigh composite flap is a reliable and versatile reconstruction method.