闭孔动脉跨区供血的长型股薄肌肌皮瓣的应用解剖学研究

Clinical Anatomy of the Long Gracilis Myocutaneous Flap Supplied by Obturator Artery

目的为闭孔动脉跨区供血的长型股薄肌肌皮瓣的临床应用提供解剖学基础。方法在38侧灌注红色乳胶的成人下肢标本上,对股薄肌上闭孔动脉和旋股内侧动脉的出现率、闭孔动脉和旋股内侧动脉在股薄肌内的走行以及闭孔动脉与旋股内侧动脉之间的吻合支等进行解剖学观测。结果闭孔动脉在股薄肌的出现率为97.37%(37侧,40支),其中有2侧是闭孔动脉与旋股内侧动脉在肌肉上端的吻合支发出分支入肌,闭孔动脉入肌点距股薄肌肌肉起点距离为(2.84±8.27)cm,起始处外径(0.62±0.45)mm;旋股内侧动脉出现率为95%,其入肌处管径(0.88±0.29)mm;闭孔动脉在股薄肌内与旋股内侧动脉吻合支的出现率为95%,主要吻合类型为终末支网状血管吻合。结论闭孔动脉及其与旋股内侧动脉的吻合支出现率高,分布具有规律性,闭孔动脉跨区供血的长型股薄肌肌皮瓣经尸体模拟实验,证明具有可行性。

Objective To provide anatomic basis for the clinic application of long gracilis myocutaneous reverse-flow flap supplied by obturator artery.Methods In 38 adult cadaver lower extremities perfused with red relax,the presence rate and the route of obturator artery and medial femoral circumflex artery within gracilis were dissected.The anatomoses between obturator artery and medial femoral circumflex artery were also observed.Results The presence rate of obturator artery in the gracilis was 97.37%(37/40).The obturator artery entered gracilis (2.84±8.27) cm below the origin of the gracilis with an outer diameter of (0.62±0.45) mm.The presence rate of medial femoral circumflex artery in the gracilis was 95%.The medial femoral circumflex artery entered the muscle with an outer diameter of (0.88±0.29) mm.The presence rate of anastomosis between the obturator artery and medial circumflex femoral artery was 95% within the gracilis,mostly in a microvascular anastomosis type.Conclusion Most medial circumflex femoral artery has a regular anastomoses with obturator artery within gracilis.The feasibility of the reverve-flow gracilis myocutaneous flap supplied by obturator artery is demonstrated by the modeling operation on the cadaver.