股外侧穿支皮瓣解剖基础和临床应用.docVIP

股外侧穿支皮瓣的解剖学基础及临床应用 南华大学附属南华医院手外科（湖南 衡阳 421002）湘雅医院骨科（湖南 长沙 410000） 【摘要】　目的　探讨股外侧穿支皮瓣血供及临床应用的可靠性。方法　对10成人尸体下肢新鲜标本灌注后,解剖观察大腿中下段皮肤血供情况,并应用12例股外侧穿支皮瓣修复四肢软组织缺损。结果　股外侧穿支皮瓣主要是由股深动脉第3穿支供血的皮瓣。于该区设计局部转移或游离皮瓣,修复四肢创面缺损,12例皮瓣成活良好,远期效果满意。结论　股外侧穿支皮瓣修复四肢软组织缺损是一种安全可靠的方法。 【关键词】股外侧　 穿支皮瓣　　解剖　　临床应用 Anatomy study and clinical application of lateral thigh perforator flap 【Abstract】　Objective　To investigate the blood vascular distribution of lateral thigh perforator flap and to discuss the reliability of its clinical application.Methods　Ten fresh adult lower extremities were used for the study, by means of injecting the media of red latex into the main artery of the limb. The skin vascular architecture of each thigh was observed to decide the blood supply of this region. Twelve patients were used to repair soft-tissue defects of extremity limb.Results　From this study, it was found that blood supply of lateral thigh perforator flap were sustained by the third perforator artery of deep femoral artery . The clinical application of the lateral thigh perforator flap was successfully carried out for the soft-tissue defects of extremity limb All of the flaps were survived well. Long-term results were satisfactory.Conclusion　The above mentioned flap is a safe and effective flap for repair the soft-tissue defects of extremity limb. 【Key words】lateral thigh; perforator flap;　anatomy;　clinical application 通过对中国人体大腿标本进行显微解剖与观测，获取股外侧皮肤血管穿支的来源、数目、分布、类型、外径与蒂长等解剖学数据资料，为股外侧穿支皮瓣的临床应用提供解剖学依据，并根据解剖学结果进行临床皮瓣设计和初步应用，取得满意效果。 1　解剖学研究 1·1　材料与方法　10具成人尸体髋关节离断新鲜标。7具男性，28~40岁，3具女性，30~60岁。8具经股动脉内灌注红乳胶150~200ml,固定后于10倍显微镜下解剖观察大腿外侧区皮肤穿支动脉来源、分支、分布及吻合情况。2具经动脉内灌注红乳胶及铅丹混合液,然后切取皮瓣行X线摄影,观察皮瓣内血管分布情况。 1·2　结果　股外侧皮肤的血液供应主要来自股二头肌和股外侧肌间隙穿支血管，不依赖于深层肌肉或筋膜的皮支。因此，皮瓣内可不包括股外侧肌和股二头肌的筋膜，仅带穿支血管即可存活，穿支的缘血管为股深动脉。股深动脉在腹股沟韧带下方3～5cm处起自股动脉,在长收肌深面沿股骨内侧走行,沿途发出4条穿支,股外侧皮肤的血液供应以第3穿支为主，第2、4穿支为辅。第2、3、4穿支相互交通，沿股骨粗线行走,发出分支到达股外侧肌和股二头肌，同时每个穿支均沿股外侧肌间隙垂直发出1~2支肌间隙皮肤穿支，皮肤穿支穿出深筋膜之后在浅筋膜层内相互交通并且与膝上外侧动脉的皮支相交通。研究显示，第2穿支在腓骨小头上方