会阴穿支皮瓣的三维显微解剖研究和临床应用初步报告
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摘要
研究背景:会阴部自体组织移植和缺损修复技术一直以来是国内、外整形外科学术界讨论的热点和难点之一,随着它的不断发展,相关解剖方面的问题也相继提出,其中穿支皮瓣是显微外科皮瓣移植的新发展,符合组织移植“受区修复重建好,供区破坏损失小”的原则。临床皮瓣移植约有80%是为了表面皮肤软组织的覆盖,仅少部分是为了填塞死腔或深部缺损。所以,仅包含皮下脂肪和皮肤的穿支皮瓣,符合“缺什么补什么”的重建原则。会阴穿支皮瓣位于股内侧上方与会阴部之间,上界过耻骨联合上缘水平约1.5cm,下界为两侧坐骨结节连线,内侧界为阴囊(唇)外侧缘,外侧界为股内侧皱襞,自阴囊(唇)外侧缘向大腿内上方延伸约6cm包括的范围。国内、外现有的关于皮瓣解剖方面的研究,基本上停留在二维研究方面,然而真正具有临床指导意义的三维解剖研究工作报导较少,原因多是缺乏灌注良好的解剖材料,显微操作技术不过硬,解剖研究脱离临床等等。会阴部组织缺损修复和重建的手术较为棘手,会阴穿支皮瓣的解剖位置毗邻会阴部、加之该区域血液供应丰富,从而决定了它是修复这些缺损的理想皮瓣。然而目前临床上鲜有报导应用此皮瓣进行会阴部缺损的修复和重建,而且部分患者手术后可能发生皮瓣部分或全部坏死,局部血液循环障碍和感觉差等问题。众所周知,详细的解剖形态学基础是设计穿支皮瓣和预测皮瓣成活面积的关键。因此,我们迫切需要对于穿支血管的数量和走行,对于吻合的血管组群,伴行的静脉回流,皮神经的分布和支配等显微解剖学基础研究方面的问题予以明确。而这些研究需要借助于一种全新的尸体标本灌注方式,显微解剖器械和显微镜,血管影像和电脑软件系统,摄影技术和图像处理系统等,将会阴穿支皮瓣的三维显微解剖结构全面呈现后,以之作为依据,用来指导临床手术的设计和完成,从而达到解剖研究与临床应用的完美结合。本研究在由我科室郭恩谭教授1990年首次报导的会阴轴型皮瓣基础上进一步深入,明确会阴穿支皮瓣的三维显微解剖结构,为临床设计、应用穿支皮瓣提供可靠依据。也为今后其它皮瓣的显微解剖研究提供一种新的思路和方法。
研究目的:本研究旨在通过对会阴区域的穿支血管、吻合的血管网、伴行静脉、皮神经的定性和定量分析,即确定它们的位置、数量、直径、穿支蒂的长度类型、来源以及穿支所供应皮肤的面积,着重研究穿支皮瓣的血管解剖基础,为临床成功的设计、应用穿支皮瓣提供解剖学依据。
研究材料与方法:10%福尔马林浸泡成人尸体11具(22侧),采用改良氧化铅一明胶灌注技术,肉眼解剖,微细结构在10倍手术放大镜下观察,游标卡尺(精确到0.2mm)测量。在尸体标本上模拟临床皮瓣切取方式,对皮瓣内包含的穿支血管、皮神经进行观测记录,然后进行深部组织解剖,追溯穿支血管、皮神经来源。所有解剖结构均进行定位、定量研究,所得结果和图像运用电脑软件分析。临床应用患者以会阴部与大腿之间的股会阴沟为长轴设计皮瓣,上界可过耻骨联合约1.5cm,下界至坐骨结节,宽可达约8cm,其中大腿侧宽约5cm,会阴侧宽约3cm。手术时按设计切开皮肤及皮下组织,在深筋膜上层由上向下解剖掀起皮瓣,至蒂部时注意保护穿支动脉,血管蒂周围组织应适当保留,将皮瓣转移至受区。供区创面直接拉拢缝合。
研究结果:大体和显微解剖研究发现:会阴区直接与间接穿支血液供应丰富,其中以阴部外浅动脉腹股沟穿支、阴部外浅动脉会阴穿支、闭孔动脉前支穿支、阴囊(唇)后动脉外侧穿支四支最具临床意义,分别位于皮瓣上、中、下方。上述四支穿支以及它们的伴行静脉彼此存在广泛的吻合,并在深筋膜层上方形成会阴区上方、中间、下方三组链式血管吻合网。以上三组血管网贯穿了皮瓣的上、中、下部。会阴区静脉回流丰富,计有阴部外浅静脉等多支知名动脉伴行静脉,并且位置恒定。皮神经支配可靠,主要有以下三组:上方有生殖股神经股皮支、髂腹股沟神经皮支,中间有阴囊(唇)后神经外侧支分支皮神经,下方有阴囊(唇)后神经外侧支分支皮神经,股后皮神经会阴支皮支。依照解剖研究结果,我们认为会阴穿支皮瓣切取方式大致为:以阴部外浅动脉腹股沟穿支和(或)会阴穿支为蒂切取皮瓣时,皮瓣蒂部切取深度应保持在1.55～1.65 cm的范围,远端部分的皮瓣可以依实际需要修薄至0.90～1.00cm的范围。穿支皮瓣依靠吻合的中、下方链式血管吻合网血供范围可以达到16×7cm左右。该皮瓣的蒂部位于上方,皮瓣成活率较高。临床上可以此血管为蒂设计上蒂会阴穿支皮瓣转移修复耻骨上区组织缺损,亦可形成游离皮瓣修复远位组织缺损;以闭孔动脉前支穿支为蒂切取皮瓣时,皮瓣蒂部切取深度应保持在1.35～1.45cm的范围,远端上、下方部分的皮瓣可以依实际需要修薄至0.90～1 .00cm的范围。穿支皮瓣依靠吻合的上、下方链式血管吻合网,血供范围可以达到14×6cm左右。该皮瓣的蒂部位于中间,临床应用此皮瓣较少;以阴囊(唇)后动脉外侧穿支为蒂切取皮瓣时,皮瓣蒂部切取深度应保持在1.25～1.35cm的范围,远端部分的皮瓣可以依实际需要修薄至0.90～1.00cm的范围。穿支皮瓣依靠吻合的中、上方链式血管吻合网,血供范围可以达到18×8cm左右。该皮瓣的蒂部位于外下方,临床上对于此皮瓣的应用非常广泛。可用于阴茎、囊和阴道再造;尿道下裂修复等手术。2005～2009年,我们应用会阴穿支皮瓣28例。男性16例,女性12例。取以阴部外浅动脉腹股沟穿支和(或)会阴穿支为血管蒂7例,闭孔动脉前支穿支血管蒂1例,以阴囊(唇)后动脉主干和(或)外侧穿支为血管蒂20例。皮瓣切取最大为17×8cm,最小10×5cm,所有患者伤口一期愈合。经6～12个月的随访,会阴部形态及修复处皮瓣均无明显改变,阴茎成形,阴道再造患者婚后性生活满意。
研究结论:会阴穿支皮瓣动脉血供充足、静脉回流丰富、又具有神经支配及淋巴回流系统。供区隐蔽,面积充分,切取后可以直接缝合,瘢痕可以隐藏于会阴部,无明显继发畸形。除具有普通穿支皮瓣薄、能兼顾外形和功能修复的优点外,还解决了其修复阴道、阴茎重要会阴部性功能器官面积受限、旋转不便等临床实际技术难题。手术在体表操作,安全、切取方便,易掌握,成功率高。运用它来修复和重建会阴部组织,外形及神经感觉均取得理想结果,是一种值得推广的方法。
[Background] The problem of correlated anatomy and physiology was raised, with the development of autografting and repairing skill on perineal position. The new development of perforating flap in area of microsurgery flap transplantation is accord with tissue transplanting principle:the recipient site is being repaired well, the donor site is being destoried little. The aim of 80 percent clinical flap planting is to cover super skin and soft tissue,only a little is to obdurate dead space or deep part defect. So the perforating flap which contains subcutaneous fat and skin is accord with―what short of what make up for‖. The perineal perforating flap is located between anodic interfemus and perineal region . It is bounded by superior border of pubic symphysis above, ischial tuberosity line below, the lateral border of scrotum or labium majus outside, and medial femoral plica inside. The area is from the lateral border of scrotum or labium majus to endo- anodic of upper leg extend 6cm. The anatomy study of flap is often retented 2D lever in our country or abroad. Yet realy 3D study which can guide clinical operation is little to be reported. The reason is that deficienting of anatomy materials, not well operating skill, and anatomy breaking away from clinic etc. The operation to repair and reconstruct perineal defect is difficult. The perineal perforating flap is ideal flap to do this work because of special anatomia position and plentiful blood supply. Nevertheless the key to design perforating flap and anticipate effect flap area is based on detailed anatomic form. Now the reason of few application of perineal perforating flap is that much study of base of microanatomy not be certained.Such as the number and courser of perforating vascular;the group of vascular anastomotic;the company venous return;and the neurocutaneous distribution and domination. Yet this study need sutible microanatomy technique and microinstrument; microscope. After clinical application of this flap to repair and rebuilt perineal position,we still find that part or total flap necrosis,region dysnemia and feeling diference etc. Therefor ,it is important for us to know the microanatomy study of perineal perforating flap so that we can do better to design and make operation. The study is based on perineal axial our division professor Guo En Tan in 1990. We identify the main perforating branch in perineal, anastomotic vascular net,venous return,cutaneous nerve innervations. Then we can design and apply the perforating flap according with them, and we also provide an new way to study other flap.
[Objective] The aim of study is to determine position, quantity, caliber, peduncular length, original vessels, and supply dermatic area of the main perforating branch by perineal region’s vessel qualitation and quantitative assay, especially in vessel anatomic basic of perforating branch flap. We can design and applicate perforating branch flap by these study.
[Materials and methods] Eleven adult cadavers (22 sides) fixed in 10% formalin were used in this study. Red latex was infused via the radial artery and external iliac artery using a modified lead oxide-gelatin infusion technique. Cadavers were dissected under an operating microscope (*10). Structures of interest were measured using a sliding caliper (accurate to 0.2 mm). We recipe flap on cadaver like clinical operation to find and observe perforating vascellum and cutaneous nerve, then we still our work to find some of them in deep part and confirm where do they come from. All anatomtic struction should be located and quantitative study,the results should be analysis by computer software.We design flap by thigh perineal drain in patients’perineal position. The border of the examined area was: superior: 1.5cm above the superior margin of pubic symphysis; inferior: the imaginary line between the two ischiadic tuberosities; medial: the lateral margin of the scrotum (labium); and lateral: interfemus plica. We recipe skin and hypoderm, then lift flap up deep fascia from down to up. The stem and tissue surrounding of flap should be preserved. We transfer the flap from donor site to recipient site. The donor site can be sutured directly.
[Results] There were 4 relatively constant perforating arteries in the perineum: inguinal and perineal perforating branches of the superficial external pudendal artery, a perforating branch of the anterior cutaneous branch of the obturator artery, and a perforating branch of the lateral branch of the posterior scrotal (pudendal) artery. All four arteries were direct perforating branches. These perforating arteries and accompanying veins overlapped with each other and formed the upper, middle and lower parts of the vascular anastomosis in deep fascia above the adductor wall. There were four important cutaneous nerves in the region originating from the following nerves: the genitofemoral nerve, ilioinguinal nerve, posterior scrotum (labium) major nerve, and rami perineales nervi cutanei femoris posterioris. The current study revealed that the upper, middle and lower perineum are supplied by distinct groups of perforating arteries, but with extensive chain type anastomosis network. Based on this finding, we propose the following strategy in designing perforator flaps: To repair the suprapubic region or distal tissue loss, the flap pedicle should be superiorly located and contain the inguinal and/or perineal perforating branches of the superficial external pudendal artery, the recipe deep of the flap stem should be keep 1.55～1.65 cm and tissues below it can be repaired thin to 0.90～1.00cm, the blood supply area depends on vascular anastomosis can be 16*7cm ; The stem of flap is located anodic and it has higher survival rate. We can use it that design anotic stem flap to repair suprapubic and amphi tissue defection. Perforator flaps with pedicle in the middle containing perforating branches from the anterior cutaneous branch of the obturator artery are not aesthetically appealing, and are also limited by the ramus inferior ossis pubis, the recipe deep of the flap stem should be keep 1.35～1.45cm and tissues below it can be repaired thin to 0.90～1.00cm, the blood supply area depends on vascular anastomosis can be 14*6cm. The stem of flap is located middle, yet clinical application is less.Perforator flaps with inferior pedicle that contains lateral branches of the posterior scrotal (labial) artery are easy to transfer, and could be used widely. The recipe deep of the flap stem should be keep 1.25～1.35cm and tissues below it can be repaired thin to 0.90～1.00cm, the blood supply area depends on vascular anastomosis can be 18*7cm . The stem of flap is located inferior , and clinical application is widespread, such as penis and scrotum reconstruction, vagina reconstruction, hypospadias reparation.2005～2009, we apply with perineal perforating flap 28 cases. 16 male, 12 female. The inguinal and/or perineal perforating branches of the superficial external pudendal artery is used as blood vessel stem 7 cases. Perforator flaps with pedicle in the middle containing perforating branches from the anterior cutaneous branch of the obturator artery is used as blood vessel stem 1 cases. Inferior pedicle that contains lateral branches of the posterior scrotal (labial) artery is used as blood vessel stem 20 cases. The largest area of flap is 17*8cm, the smallest area of flap is 10*5cm,all patients’wounds are primary healing. With 6～12 months follow up, the perineal regions of patients are not obviously alter. Some patients who have their penis or vagina reconstructed are satisfied with sex life.
[Conclusion] The perineum has abundant blood supply, venous return, and innervation. Due to its covert location and manoeuvrability, perforator flaps from this region are good sources of donor tissue for perineal reconstruction.The perforator flap has not only thin like other flap but also solve questions of limited area and difficult revolve. The operation is safe, easy to grasp, high achievement ratio. The perinel perforator flap is good at repairing the defection of tissue. All patients feel good after operation. It is a good way to extend.
研究目的:本研究旨在通过对会阴区域的穿支血管、吻合的血管网、伴行静脉、皮神经的定性和定量分析,即确定它们的位置、数量、直径、穿支蒂的长度类型、来源以及穿支所供应皮肤的面积,着重研究穿支皮瓣的血管解剖基础,为临床成功的设计、应用穿支皮瓣提供解剖学依据。
研究材料与方法:10%福尔马林浸泡成人尸体11具(22侧),采用改良氧化铅一明胶灌注技术,肉眼解剖,微细结构在10倍手术放大镜下观察,游标卡尺(精确到0.2mm)测量。在尸体标本上模拟临床皮瓣切取方式,对皮瓣内包含的穿支血管、皮神经进行观测记录,然后进行深部组织解剖,追溯穿支血管、皮神经来源。所有解剖结构均进行定位、定量研究,所得结果和图像运用电脑软件分析。临床应用患者以会阴部与大腿之间的股会阴沟为长轴设计皮瓣,上界可过耻骨联合约1.5cm,下界至坐骨结节,宽可达约8cm,其中大腿侧宽约5cm,会阴侧宽约3cm。手术时按设计切开皮肤及皮下组织,在深筋膜上层由上向下解剖掀起皮瓣,至蒂部时注意保护穿支动脉,血管蒂周围组织应适当保留,将皮瓣转移至受区。供区创面直接拉拢缝合。
研究结果:大体和显微解剖研究发现:会阴区直接与间接穿支血液供应丰富,其中以阴部外浅动脉腹股沟穿支、阴部外浅动脉会阴穿支、闭孔动脉前支穿支、阴囊(唇)后动脉外侧穿支四支最具临床意义,分别位于皮瓣上、中、下方。上述四支穿支以及它们的伴行静脉彼此存在广泛的吻合,并在深筋膜层上方形成会阴区上方、中间、下方三组链式血管吻合网。以上三组血管网贯穿了皮瓣的上、中、下部。会阴区静脉回流丰富,计有阴部外浅静脉等多支知名动脉伴行静脉,并且位置恒定。皮神经支配可靠,主要有以下三组:上方有生殖股神经股皮支、髂腹股沟神经皮支,中间有阴囊(唇)后神经外侧支分支皮神经,下方有阴囊(唇)后神经外侧支分支皮神经,股后皮神经会阴支皮支。依照解剖研究结果,我们认为会阴穿支皮瓣切取方式大致为:以阴部外浅动脉腹股沟穿支和(或)会阴穿支为蒂切取皮瓣时,皮瓣蒂部切取深度应保持在1.55～1.65 cm的范围,远端部分的皮瓣可以依实际需要修薄至0.90～1.00cm的范围。穿支皮瓣依靠吻合的中、下方链式血管吻合网血供范围可以达到16×7cm左右。该皮瓣的蒂部位于上方,皮瓣成活率较高。临床上可以此血管为蒂设计上蒂会阴穿支皮瓣转移修复耻骨上区组织缺损,亦可形成游离皮瓣修复远位组织缺损;以闭孔动脉前支穿支为蒂切取皮瓣时,皮瓣蒂部切取深度应保持在1.35～1.45cm的范围,远端上、下方部分的皮瓣可以依实际需要修薄至0.90～1 .00cm的范围。穿支皮瓣依靠吻合的上、下方链式血管吻合网,血供范围可以达到14×6cm左右。该皮瓣的蒂部位于中间,临床应用此皮瓣较少;以阴囊(唇)后动脉外侧穿支为蒂切取皮瓣时,皮瓣蒂部切取深度应保持在1.25～1.35cm的范围,远端部分的皮瓣可以依实际需要修薄至0.90～1.00cm的范围。穿支皮瓣依靠吻合的中、上方链式血管吻合网,血供范围可以达到18×8cm左右。该皮瓣的蒂部位于外下方,临床上对于此皮瓣的应用非常广泛。可用于阴茎、囊和阴道再造;尿道下裂修复等手术。2005～2009年,我们应用会阴穿支皮瓣28例。男性16例,女性12例。取以阴部外浅动脉腹股沟穿支和(或)会阴穿支为血管蒂7例,闭孔动脉前支穿支血管蒂1例,以阴囊(唇)后动脉主干和(或)外侧穿支为血管蒂20例。皮瓣切取最大为17×8cm,最小10×5cm,所有患者伤口一期愈合。经6～12个月的随访,会阴部形态及修复处皮瓣均无明显改变,阴茎成形,阴道再造患者婚后性生活满意。
研究结论:会阴穿支皮瓣动脉血供充足、静脉回流丰富、又具有神经支配及淋巴回流系统。供区隐蔽,面积充分,切取后可以直接缝合,瘢痕可以隐藏于会阴部,无明显继发畸形。除具有普通穿支皮瓣薄、能兼顾外形和功能修复的优点外,还解决了其修复阴道、阴茎重要会阴部性功能器官面积受限、旋转不便等临床实际技术难题。手术在体表操作,安全、切取方便,易掌握,成功率高。运用它来修复和重建会阴部组织,外形及神经感觉均取得理想结果,是一种值得推广的方法。
[Background] The problem of correlated anatomy and physiology was raised, with the development of autografting and repairing skill on perineal position. The new development of perforating flap in area of microsurgery flap transplantation is accord with tissue transplanting principle:the recipient site is being repaired well, the donor site is being destoried little. The aim of 80 percent clinical flap planting is to cover super skin and soft tissue,only a little is to obdurate dead space or deep part defect. So the perforating flap which contains subcutaneous fat and skin is accord with―what short of what make up for‖. The perineal perforating flap is located between anodic interfemus and perineal region . It is bounded by superior border of pubic symphysis above, ischial tuberosity line below, the lateral border of scrotum or labium majus outside, and medial femoral plica inside. The area is from the lateral border of scrotum or labium majus to endo- anodic of upper leg extend 6cm. The anatomy study of flap is often retented 2D lever in our country or abroad. Yet realy 3D study which can guide clinical operation is little to be reported. The reason is that deficienting of anatomy materials, not well operating skill, and anatomy breaking away from clinic etc. The operation to repair and reconstruct perineal defect is difficult. The perineal perforating flap is ideal flap to do this work because of special anatomia position and plentiful blood supply. Nevertheless the key to design perforating flap and anticipate effect flap area is based on detailed anatomic form. Now the reason of few application of perineal perforating flap is that much study of base of microanatomy not be certained.Such as the number and courser of perforating vascular;the group of vascular anastomotic;the company venous return;and the neurocutaneous distribution and domination. Yet this study need sutible microanatomy technique and microinstrument; microscope. After clinical application of this flap to repair and rebuilt perineal position,we still find that part or total flap necrosis,region dysnemia and feeling diference etc. Therefor ,it is important for us to know the microanatomy study of perineal perforating flap so that we can do better to design and make operation. The study is based on perineal axial our division professor Guo En Tan in 1990. We identify the main perforating branch in perineal, anastomotic vascular net,venous return,cutaneous nerve innervations. Then we can design and apply the perforating flap according with them, and we also provide an new way to study other flap.
[Objective] The aim of study is to determine position, quantity, caliber, peduncular length, original vessels, and supply dermatic area of the main perforating branch by perineal region’s vessel qualitation and quantitative assay, especially in vessel anatomic basic of perforating branch flap. We can design and applicate perforating branch flap by these study.
[Materials and methods] Eleven adult cadavers (22 sides) fixed in 10% formalin were used in this study. Red latex was infused via the radial artery and external iliac artery using a modified lead oxide-gelatin infusion technique. Cadavers were dissected under an operating microscope (*10). Structures of interest were measured using a sliding caliper (accurate to 0.2 mm). We recipe flap on cadaver like clinical operation to find and observe perforating vascellum and cutaneous nerve, then we still our work to find some of them in deep part and confirm where do they come from. All anatomtic struction should be located and quantitative study,the results should be analysis by computer software.We design flap by thigh perineal drain in patients’perineal position. The border of the examined area was: superior: 1.5cm above the superior margin of pubic symphysis; inferior: the imaginary line between the two ischiadic tuberosities; medial: the lateral margin of the scrotum (labium); and lateral: interfemus plica. We recipe skin and hypoderm, then lift flap up deep fascia from down to up. The stem and tissue surrounding of flap should be preserved. We transfer the flap from donor site to recipient site. The donor site can be sutured directly.
[Results] There were 4 relatively constant perforating arteries in the perineum: inguinal and perineal perforating branches of the superficial external pudendal artery, a perforating branch of the anterior cutaneous branch of the obturator artery, and a perforating branch of the lateral branch of the posterior scrotal (pudendal) artery. All four arteries were direct perforating branches. These perforating arteries and accompanying veins overlapped with each other and formed the upper, middle and lower parts of the vascular anastomosis in deep fascia above the adductor wall. There were four important cutaneous nerves in the region originating from the following nerves: the genitofemoral nerve, ilioinguinal nerve, posterior scrotum (labium) major nerve, and rami perineales nervi cutanei femoris posterioris. The current study revealed that the upper, middle and lower perineum are supplied by distinct groups of perforating arteries, but with extensive chain type anastomosis network. Based on this finding, we propose the following strategy in designing perforator flaps: To repair the suprapubic region or distal tissue loss, the flap pedicle should be superiorly located and contain the inguinal and/or perineal perforating branches of the superficial external pudendal artery, the recipe deep of the flap stem should be keep 1.55～1.65 cm and tissues below it can be repaired thin to 0.90～1.00cm, the blood supply area depends on vascular anastomosis can be 16*7cm ; The stem of flap is located anodic and it has higher survival rate. We can use it that design anotic stem flap to repair suprapubic and amphi tissue defection. Perforator flaps with pedicle in the middle containing perforating branches from the anterior cutaneous branch of the obturator artery are not aesthetically appealing, and are also limited by the ramus inferior ossis pubis, the recipe deep of the flap stem should be keep 1.35～1.45cm and tissues below it can be repaired thin to 0.90～1.00cm, the blood supply area depends on vascular anastomosis can be 14*6cm. The stem of flap is located middle, yet clinical application is less.Perforator flaps with inferior pedicle that contains lateral branches of the posterior scrotal (labial) artery are easy to transfer, and could be used widely. The recipe deep of the flap stem should be keep 1.25～1.35cm and tissues below it can be repaired thin to 0.90～1.00cm, the blood supply area depends on vascular anastomosis can be 18*7cm . The stem of flap is located inferior , and clinical application is widespread, such as penis and scrotum reconstruction, vagina reconstruction, hypospadias reparation.2005～2009, we apply with perineal perforating flap 28 cases. 16 male, 12 female. The inguinal and/or perineal perforating branches of the superficial external pudendal artery is used as blood vessel stem 7 cases. Perforator flaps with pedicle in the middle containing perforating branches from the anterior cutaneous branch of the obturator artery is used as blood vessel stem 1 cases. Inferior pedicle that contains lateral branches of the posterior scrotal (labial) artery is used as blood vessel stem 20 cases. The largest area of flap is 17*8cm, the smallest area of flap is 10*5cm,all patients’wounds are primary healing. With 6～12 months follow up, the perineal regions of patients are not obviously alter. Some patients who have their penis or vagina reconstructed are satisfied with sex life.
[Conclusion] The perineum has abundant blood supply, venous return, and innervation. Due to its covert location and manoeuvrability, perforator flaps from this region are good sources of donor tissue for perineal reconstruction.The perforator flap has not only thin like other flap but also solve questions of limited area and difficult revolve. The operation is safe, easy to grasp, high achievement ratio. The perinel perforator flap is good at repairing the defection of tissue. All patients feel good after operation. It is a good way to extend.
引文
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[1] Lin CT, Huang JS, Hsu KC, et al.Different types of suprafascial courses in thoracodorsal artery skin perforators.Plast Reconstr Surg. 2008 Mar;121(3):840-848. (PMID: 18317133)
[2] Ganatra MA, Ansari NU. Pudendal thigh flap for congenital absence of vagina.[J] Pak Med Assoc. 2005 Apr;55(4):143-5. (PMID: 15918624)
[3] Kronowitz SJRedesigned gluteal artery perforator flap for breast reconstruction. Plast Reconstr Surg. 2008 Mar;121(3):728-34. (PMID: 18317122)
[4]郭恩覃,季正伦,张明利,等。会阴轴性皮瓣再造阴道。中华外科杂志,1990,28(9):552-554。
[5] Hamdi M, Spano A, Van Landuyt K, et al.The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery.Plast Reconstr Surg. 2008 Feb;121(2):389-96. (PMID: 18300954)
[6]张世民,徐达传,顾玉东.穿支皮瓣[J].中国临床解剖学杂志,2004,22 (1):32-35。
[2]Wee JTK, Joseph VT. A new technique of vaginal reconstruction using neurovascular pudendal thigh flap: a preliminary report. Plast Reconstruction Surg 1989;83:701–709
[3]Chen zong ji, chen chao et al. Vaginal Reconstruction Using Perineal-thigh Flaps with Subcutaneous Pedicle. Chin Med Sci J, 1991,6 (1):14-18
[4]郭恩覃,季正伦,张明利,等。会阴轴性皮瓣再造阴道。中华外科杂志,1990,28(9):552-556
[5]党瑞山,傅惠娟,纪荣明,等.阴股沟皮瓣用于阴道再造的应用解剖[J].解剖学杂志,1991,14:107-109
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