带肉膜蒂阴茎皮瓣的应用解剖

Clinical anatomic study on the pedicled-dartos penile skin flap

目的 :为带肉膜蒂的阴茎皮瓣提供解剖学基础。方法 :成人男性防腐尸体 15具 ,逐层解剖阴茎 ,观察各层结构和血液供应 ,以及层与层之间的联系 ;3具新鲜尸体 ,模拟不同切取阴茎皮瓣手术。结果 :阴茎肉膜疏松 ,伸缩性好 ;深筋膜致密 ,伸缩性差。阴茎背浅动脉走在阴茎背外侧的肉膜层 ,起点外径为 0 .8± 0 .2mm ;阴茎背动脉走在深筋膜层 ,起点外径为 1.5± 0 .3mm。阴茎背动脉发出分支支配阴茎头和尿道 ;阴茎包皮同时接受阴茎背浅动脉和阴茎背动脉的血供。可作为皮瓣蒂部的组织有三种 :肉膜、肉膜 +Buck氏筋膜和Buck氏筋膜。肉膜蒂皮瓣可保留皮瓣、阴茎头和尿道的供血动脉 ,容易切取和转位 ;Buck氏筋膜蒂皮瓣无这些特性。结论 :设计带肉膜蒂阴茎皮瓣应是 :皮瓣的远端在Buck氏筋膜的浅面 ,近端在肉膜的浅面 ,宽度包括阴茎背外侧 ,蒂部由阴茎肉膜组成 ,供血动脉是阴茎背浅动脉。

Objective: To provide anatomic basis for the dartos-pedicled skin flap. Methods: The constructions, the relationships, and the distribution of the arteries of the penile were observed in 15 adult male specimens by microanatomy, while different pedicle penile skin flap were developed in 3 fresh male specimens. Results: The penile dartos was loose, however the deep fascia was dense with poor elasticity. The superficial dorsal penile artery run in the dartos layer, whose external diameter was 0.83±0.18 mm, while the dorsal artery of penis run in the Buck`s fascia, whose external diameter was 1.45±0.28 mm. The dorsal penile artery supplied the head of the penis and the urethra. There were three kinds of tissues which can act as the pedicle of the penile flap, the dartos, the dartos plus Buck's fascia, and the Buck's fascia. The dartos-pedicled skin flap can be easily developed and dislocated, while it could maintain the blood supply for the flap, the head of the penis and the urethra. The Buck's fascia-pedicled skin flap absented these characteristics. Conclusion: The optional pedicle skin flap of the penis is dartos-pedicled flap, whose blood supply is the superficial dorsal penile artery with the dartos acting as the pedicle, and its range includes the posterior-dorsal penile skin.