中国临床解剖学杂志 ›› 2010, Vol. 28 ›› Issue (3): 242-.

• 应用解剖 • 上一篇    下一篇

逆行缝匠肌皮瓣修复小腿皮肤缺损应用解剖学

左荣跃1, 史增元2, 尹维刚1, 俞 淼2, 毛海蛟1   

  1. 1.宁波大学医学院; 2.宁波大学医学院附属医院骨科,  浙江   宁波    315211
  • 收稿日期:2010-02-03 出版日期:2010-05-25 发布日期:2010-06-11
  • 通讯作者: 史增元,主任医师,硕士生导师,Tel:(0574)87035151,E-mail:szy580@sohu.com E-mail:zuory28 @yeah.net
  • 作者简介:左荣跃(1981-),男,安徽蚌埠人,在读硕士研究生,主要从事创伤骨科和应用解剖研究

The repair of leg skin defect by the retrograde sartorius myocutaneous flap:clinical anatomy

ZUO Rong-yue, SHI Zeng-yuan, YIN Wei-gang, et al.   

  1. Medical Academy in Ningbo University, Ningbo 315020,  China
  • Received:2010-02-03 Online:2010-05-25 Published:2010-06-11

摘要:

目的 为设计逆行缝匠肌皮瓣转位修复小腿皮肤缺损提供解剖学基础。 方法 解剖观测 40侧缝匠肌的动脉来源、走行、外径、分布及吻合。取4侧新鲜成尸下肢标本进行动脉造影,观察缝匠肌内动脉吻合。 结果    营养缝匠肌的动脉为6~7支,呈节段性分布,缝匠肌的上1/5段动脉来源于旋髂浅动脉、旋股外侧动脉或股深动脉,中2/5段动脉来源于股动脉,下2/5段动脉来源于隐动脉。隐动脉起点位于内收肌结节上(10.2±1.0)cm处,外径(1.5±0.2)mm,向下发出3~5个分支入缝匠肌,隐动脉终末支在膝下内侧参与膝关节网。缝匠肌的各节段动脉在肌内分为4~7支沿缝匠肌纵轴走行,相邻动脉的分支在肌内形成链型吻合,吻合处外径0.3 mm左右。深筋膜表面有皮动脉和肌皮动脉形成的链式血管吻合网,营养缝匠肌表面的皮肤。 结论    缝匠肌内动脉链型吻合为逆行缝匠肌皮瓣供血,扩大了该肌皮瓣的切取长度,故以隐动静脉为血管蒂的逆行缝匠肌皮瓣可修复小腿中下段软组织缺损。

关键词: 缝匠肌!肌皮瓣!小腿!皮肤缺损

Abstract:

Objective To provide anatomic basis for repairing leg skin defects by the retrograde sartorius myocutaneous flap.   Methods The origin, course, diameter, distribution and  anastomosis of sartorius's arteries were explored in 40 cadaveric lower limb specimens. Arteriographies were made in 4 sides of fresh specimens to study the arterial anastomosis in sartorius.  Results    Nutrient arteries of sartorius represented segmental distribution, including 6~7 branches. The arterial branches in the proximal 1/5 of sartorius came from superficial ilium circumflex artery, lateral femoral circumflex artery or deep femoral artery, in the middle 2/5 from femoral artery, and in the distal 2/5 from saphenous artery, respectively. The diameter of saphenous artery at the origin was about (1.5±0.2)mm, which was near the proximal level of adductor tubercle about (10.2±1.0)cm, and gave rise to 3~5 branches before reaching into  sartorius. The terminal branches of saphenous artery composed an arterial network around knee joint below and inside the knee joint. Segmental arteries entered into sartorius and passed along it's vertical axis with 4~7 branches. Link-pattern arterial anastomosises were formed by branches of adjacent vascular pedicles. The diameter was about 0.3 mm at anastomosis point. Cutaneous arteries and musculocutaneous arteries above deep fascia formed interlocking arterial anastomosis net which provided blood supply for the skin on sartorius.   Conclusions    Interlocking arterial anastomosises in sartorius provide blood supply for retrograde sartorius myocutaneous flap,and enlarge its cutting length. Retrograde sartorius myocutaneous flap pedicled with saphenous artery can be used to repair soft tissue defect of the middle and distal legs.

Key words: Sartorius!Myocutaneous flap!Leg!Skin defect

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