腓肠内侧动脉穿支皮瓣的应用解剖及临床研究

doi:10.19438/j.cjoms.2018.06.005

中国口腔颌面外科杂志 ›› 2018, Vol. 16 ›› Issue (6): 505-510.doi: 10.19438/j.cjoms.2018.06.005

腓肠内侧动脉穿支皮瓣的应用解剖及临床研究

孙秋望月, 高鹏飞, 王晨星, 宋晓萌, 丁旭, 李怀奇, 武和明, 吴煜农, 袁冶, 叶金海^*, 李中连^*

南京医科大学口腔疾病研究江苏省重点实验室, 南京医科大学附属口腔医院口腔颌面外科,江苏南京 210029

收稿日期:2018-09-21 出版日期:2018-11-20 发布日期:2019-01-11
通讯作者: 叶金海,E-mail:yjh98001@163.com; 李中连,E-mail: lizhonglian2009@163.com,现在无锡市锡山人民医院工作。^*共同通信作者
作者简介:孙秋望月（1993-）,女,硕士研究生,E-mail: 13375206188@163.com
基金资助:
国家自然科学基金（81371123）; 江苏省“十三五”科教强卫工程医学重点人才项目（ZDRCA2016087）; 江苏高校优势学科建设工程资助项目（2018-87）

Applied anatomic study and clinical application of medial sural artery perforator flap

SUN Qiuwangyue, GAO Peng-fei, WANG Chen-xing, SONG Xiao-meng, DING Xu, LI Huai-qi, WU He-ming, WU Yu-nong, YUAN Ye, YE Jin-hai, LI Zhong-lian

Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Nanjing Medical University. Nanjing 210029, Jiangsu Province, China

Received:2018-09-21 Online:2018-11-20 Published:2019-01-11

摘要/Abstract

摘要： 目的: 通过对腓肠内侧动脉穿支皮瓣的解剖学研究,探讨制备腓肠内侧动脉穿支皮瓣的合理性及稳定性;并对临床上应用腓肠内侧动脉穿支皮瓣修复的患者的供区及受区术后恢复情况等进行随访,评价其在口腔颌面部缺损修复重建中的应用价值。方法: 选取 6 例中国成人下肢标本,解剖并记录腓肠内侧动脉穿支的数目、分布、部分层面血管外径及各段血管长度;同时对16 例口腔鳞癌术后缺损患者采用腓肠内侧动脉穿支皮瓣进行修复重建,皮瓣面积 3 cm×4 cm~6 cm×8 cm。术后随访12 个月,观察皮瓣存活情况,受区臃肿度,供区功能恢复,术后吞咽及语言功能情况。结果: 6 例下肢标本共测量记录到腓肠内侧动脉穿支14 条,平均 2.3 条。小腿腓肠内侧动脉穿支平均距腘皱褶下缘（9.15±4.05）cm, 距后正中线（2.82±0.91）cm,源动脉起始处外径平均为（2.11±0.17）mm。血管蒂总长度平均为（12.61±3.15）cm;16 例腓肠内侧动脉穿支皮瓣,2 例发生血管危象并部分坏死,2 例失访（术后随访 10~47 个月,平均 24 个月）。2例皮瓣移植发生血管危象伴部分坏死病例未纳入随访。腓肠内侧动脉穿支皮瓣存活率较高,供区影响小,组织量适中,受区外形不臃肿,质地、弹性良好,吞咽、语言功能均无明显影响。结论: 腓肠内侧动脉穿支皮瓣穿支数目及分布稳定,血管蒂长度及管径完全满足游离皮瓣移植要求,供区影响小,组织量适中,皮瓣受区不臃肿。结合其解剖稳定性,是口腔颌面部软组织中小型缺损修复重建的理想选择。

关键词: 穿支皮瓣, 应用解剖, 腓肠内侧穿支皮瓣

Abstract: PURPOSES: To provide anatomic evidence for clinical application of medial sural artery perforator flaps (MSAP), this study compared the contour and function of donor site and recipient site pre- and post-operatively in order to investigate the clinical value in reconstruction of oral and maxillofacial defects. METHODS: Six lower limbs of Chinese adult cadavers were micro-surgically dissected and the number of perforators was recorded based on medial sural artery perforator flaps, the external diameters, pedicle lengths, and locations were measured. Sixteen clinical cases using medial sural artery perforator flaps for reconstruction were selected from May 2011 to May 2014, the flap size ranged from 3 cm×4 cm to 6 cm×8 cm. The patients were evaluated at 3, 6 and 12 months postoperatively including flap survival number, contour and function of recipient and donor site, and their swallowing and speech function after reconstruction of the tongue and/or floor of mouth. RESULTS: Totally 14 medial sural artery perforators (each leg had 2.3 on average) were found in 6 legs. The average longitudinal distance from the medial sural artery perforators to popliteal crease was (9.15 ±4.05) cm, and (2.82±0.91)cm to posterior midline of the leg. The external diameter of vessel pedicle was (2.11±0.17) mm, and the pedicle length was (12.61±3.15) cm. Among the 16 medial sural artery perforator flaps, two flap had venous crisis and eventually developed necrosis, two patients were lost to follow up. All the cases were followed up for 10-47 months (mean 24 months), two cases with flap necrosis were excluded. Medial sural artery perforator flap was favorable in donor site morbidity, swallowing and speech function. CONCLUSIONS: Medial sural artery perforator flap has a good anatomic stability, with vascular pedicle length and diameter completely meeting requirements of the clinic, which is an ideal choice to reconstruct small or medium-sized oral and maxillofacial defects.

Key words: Perforator flap, Applied anatomy, Medial sural artery perforator flap

中图分类号:

R782.2

孙秋望月, 高鹏飞, 王晨星, 宋晓萌, 丁旭, 李怀奇, 武和明, 吴煜农, 袁冶, 叶金海, 李中连. 腓肠内侧动脉穿支皮瓣的应用解剖及临床研究[J]. 中国口腔颌面外科杂志, 2018, 16(6): 505-510.

SUN Qiuwangyue, GAO Peng-fei, WANG Chen-xing, SONG Xiao-meng, DING Xu, LI Huai-qi, WU He-ming, WU Yu-nong, YUAN Ye, YE Jin-hai, LI Zhong-lian. Applied anatomic study and clinical application of medial sural artery perforator flap[J]. China J Oral Maxillofac Surg, 2018, 16(6): 505-510.

参考文献

[1] Koshima I, Soeda S.Inferior epigastric artery skin flaps without rectus abdominis muscle[J]. Br J Plast Surg, 1989, 42(6): 645-648.
[2] Hallock GG.Anatomic basis of the gastrocnemius perforator-based flap[J]. Ann Plast Surg, 2001, 47(5): 517-522.
[3] Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-de la Cámara A, et al. The medial sural artery perforator free flap[J]. Plast Reconstr Surg, 2001, 108(6): 1609-1617.
[4] 张功林, 章鸣, 张金福, 等. 腓肠内侧动脉穿支带蒂皮瓣修复髌前软组织缺损[J]. 中华骨科杂志, 2007, 27(2): 144-145.
[5] Zheng H, Liu J, Dai X, et al.Free conjoined or chimeric medial sural artery perforator flap for the reconstruction of multiple defects in hand[J]. J Plast Reconstr Aesthet Surg, 2015, 68(4): 565-570.
[6] Hallock GG.Medial sural artery perforator free flap: legitimate use as a solution for the ipsilateral distal lower extremity defect[J]. J Reconstr Microsurg, 2014, 30(3): 187-192.
[7] Lóderer Z, Bognár G, Novák A, et al.Medial sural artery perforator fasciocutaneous flap for the reconstruction of tongue and mouth base[J]. Magy Seb, 2013, 66(4): 194-197.
[8] Wong MZ, Wong CH, Tan BK, et al.Surgical anatomy of the medial sural artery perforator flap[J]. J Reconstr Microsurg, 2012, 28(8): 555-560.
[9] Dusseldorp JR, Pham QJ, Ngo Q, et al.Vascular anatomy of the medial sural artery perforator flap: a new classification system of intra-muscular branching patterns[J]. J Plast Reconstr Aesthet Surg, 2014, 67(9): 1267-1275.
[10] He Y, Jin SF, Zhang ZY, et al.A prospective study of medial sural artery perforator flap with computed tomographic angiography-aided design in tongue reconstruction[J]. J Oral Maxillofac Surg, 2014, 72(11): 2351-2365.
[11] 卿黎明, 胡懿郃, 唐举玉, 等. 基于数字化技术的腓肠内侧动脉穿支皮瓣血供的三维可视化重建研究[J].中国修复重建外科杂志, 2014, 28(6): 697-699.
[12] Hung SY, Loh CY, Kwon SH, et al.Assessing the suitability of medial sural artery perforator flaps in tongue reconstruction - An outcome study[J]. PLoS One, 2017, 12(2): e0171570.
[13] Agrawal G, Gupta A, Chaudhary V, et al.Medial sural artery perforator flap for head and neck reconstruction[J]. Ann Maxillofac Surg, 2018, 8(1): 61-65.
[14] Cina A, Salgarello M, Barone-Adesi L, et al.Planning breast reconstruction with deep inferior epigastric artery perforating vessels: multidetector CT angiography versus color Doppler US[J]. Radiology, 2010, 255(3): 979-987.
[15] Zhao WQ, Li Z, Wu L, et al.Medial sural artery perforator flap aided by ultrasonic perforator localization for reconstruction after oral carcinoma resection[J]. J Oral Maxillofac Surg, 2016, 74(5): 1063-1071.
[16] Shen XQ, Lv Y, Shen H, et al.Endoscope-assisted medial sural artery perforator flap for head and neck reconstruction[J]. J Plastic Reconstr Aesthetic Surg, 2016, 69(8): 1059-1065.

腓肠内侧动脉穿支皮瓣的应用解剖及临床研究

Applied anatomic study and clinical application of medial sural artery perforator flap

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