Objective To observe and design the gluteal epithelial neurovascular flap pedicled with perforator of fourth lumbar artery, so as to provide anatomical and morphological basis for the clinical application. Methods Anatomical observation of 15 cases (30 sides) adult Chinese specimen of waist-hip region were performed. The distribution of posterior branch of the fourth lumbar artery, gluteal epithelial nerve and its subdivision branch were observed at the position of deep fascial perforation point. Measure The outer diameter of the posterior branch of the fourth lumbar artery, and the length of middle branch of the gluteal epithelial nerve were measured. On the basis of applied anatomy, the gluteal epithelial neurovascular flap pedicled with perforator of fourth lumbar artery was designed and applied to repair huge wounds in sacrococcygeal tracts in 12 cases. Results The external diameter of the fourth lumbar artery's posterior branch penetrated the deep fascia was (1.16±0.43) mm, with 63.3% represented by single branches in 19 out of 30 instances. In 11 cases, the artery was divided into 2~3 branches before penetrating the deep fascia, accounting for 27.7%. The length of the intermediate branch of gluteal epithelial nerves was (147.82±16.37) mm. The design area of the gluteal fascial flap were the following the superior boundary was 2~4 cm from the rotation point, the inferior boundary was the superior part of the gluteus maximus, the inside of superior boundary was the posterior median line, the lateral side was posterior axillary line. The flap size was 17.4 cm×12.5 cm~25.4 cm×18.3 cm. Length-width ratio of the flap was (3~5): 1. Twelve cases of large sacrococcygeal wounds were repaired by the 4th lumbar artery perforated gluteal neurotrophic vascular flap. All the flaps survived and the effects were satisfactory. Conclusions The blood supply of the flap is mainly from the posterior branch of the fourth lumbar artery, the gluteal epithelial nerve and its branch innervation, which has certain regularity and predictability. This flap is easy to design, constant and clear anatomy, covers a large area, and is easy to operate, making it an ideal method for repairing huge wounds in the sacrococcygealgeal.
Key words
Gluteal epithelial neurovascular flap /
Fourth lumbar artery /
Anatomical observation; /
Wound repair
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 侍朋举, 孙柏山,张瑞杰,等. 内外联合固定结合Ⅱ期穿支血管蒂皮瓣治疗Gustilo-Anderson ⅢB及ⅢC型踝关节骨折脱位[J]. 中国骨伤,2020, 33(7): 596-601. DOI: 10.12200/j.issn.1003-0034.2020.07.002
[2] Liu WC, Wen C, Wang Z. Volar Neurovascular Advancement Flap With an All Neural Branch-preserving Technique[J]. Tech Hand Up Extrem Surg, 2020, 25(2):63-68. DOI: 10.1097/BTH.0000000000000306.
[3] Dabestani PJ, Ramsey MD, Chappell AG, et al. Free Vascularized Fibular Flap with Bilateral Bipolar Latissimus Transfer for Upper Extremity Reconstruction: A Case Report[J]. JBJS Case Connect, 2022,12(4). DOI: 10.2106/JBJS.CC.22.00286.
[4] Gutierrez WR, Bennion DM, Walsh JE, et al. Vascular pedicled flaps for skull base defect reconstruction[J].Laryngoscope Investig Otolaryngol, 2020,5(6):1029-1038. DOI:10.1002/lio2.471.
[5] 魏在荣, 陈伟. 皮瓣移植神经功能重建的研究进展[J]. 遵义医学院学报, 2016, 39(1):1-5. DOI:10.14169/j.cnki.zunyixuebao.2016.0001.
[6] 陆伟,于国中. 游离皮瓣感觉恢复的观察与评价[J]. 中华显微外科杂志, 1993, 16 (3):177-180.
[7] 叶小宾, 陈镇国, 谢运煌,等. 踝前穿支血管蒂皮瓣修复足踝部皮肤软组织缺损[J]. 实用手外科杂志,2020,34(2):223-224. DOI:10.3969/j.issn.1671-2722.2020.02.035.
[8] 刘小俊, 武彬, 姚毅. 双侧旋转皮瓣在头皮缺损创面修复中的应用[J]. 中华损伤与修复杂志（电子版）, 2015,10(5):42-43. DOI:10.3877/cma.j.issn.1673-9450.2015.05.010.
[9] 金文虎, 李海, 常树森, 等. 臀上动脉穿支蒂V-Y推进皮瓣治疗骶尾部压疮的效果评价[J]. 中华创伤杂志,2019,35(12):1138-1141. DOI:10.3760/cma.j.issn.1001-8050.2019.12.014.
[10]苗华, 严麟书.国人背下部和腰部脊神经后支的解剖学观察[J].蚌埠医学院学报,1981,(1):7-14.
[11] 徐永清,范新宇. 不同皮瓣在创面修复中的应用[J]. 中华创伤杂志,2016,32(4):291-294. DOI:10.3760/cma.j.issn.1001-8050.2016.04.002.
[12] 黄啟云,林红华. 改良全臀大肌旋转肌皮瓣治疗骶尾部压疮的疗效观察[J]. 实用骨科杂志,2019,25(8):746-748. DOI:10.13795/j.cnki.sgkz.2019.08.018.
[13] 李士民, 刘林嶓, 周树萍, 等. 顺行带蒂股前外侧皮瓣修复臀部复杂性褥疮[J]. 中华创伤杂志, 2015,31(5):447-449. DOI:10.3760/cma.j.issn.1001-8050.2015.05.017.
[14] Winter R, Steinböck M, Leinich W, et al. The reverse latissimus dorsi flap: An anatomical study and retrospective analysis of its clinical application[J]. J Plast Reconstr Aesthet Surg,2019,72(7):1084-1090. DOI: 10.1016/j.bjps.2019.03.010.
[15] 李澎, 李诚, 李靖年, 等.臀上皮神经营养血管筋膜皮瓣移植的应用解剖特点[J].中国组织工程研究与临床康复,2008,12(53):10432-10436. DOI: 10.3321/j.issn:1673-8225.2008.53.016.
[16] 朱正新. 腹部带血管蒂皮瓣修复术治疗手部烧伤缺损的效果及影响因素探析[J].中国医学创新, 2021,18(20):9-12.DOI: 10.3969/j.issn.1674-4985.2021.20.003.
[17] Heim N, Wilms CT. Plastische Deckung eines ausgedehnten Defekts nach Entfernung zweier kutaner Plattenepithelkarzinome mittels doppeltem vaskularisierten Brückenlappen am Skalp [Plastic-surgical coverage of an extended defect on the scalp using a bipedicled vascularised flap after removal of two cutaneous squamous epithelial carcinomas][J]. Handchir Mikrochir Plast Chir, 2021,53(6):548-551. DOI: 10.1055/a-1425-5434.
PDF(4374 KB)
