Schultes G, Kärcher H, Gaggl A, Anderhuber F
Department of Maxillofacial Surgery, University of Graz, Austria.
Surg Radiol Anat. 1999;21(2):91-4. doi: 10.1007/s00276-999-0091-0.
Vascularized nerve transplants can lead to satisfactory functional reconstruction for nerve defects. These include defects following traumatic nerve severance, iatrogenic severance during tumour resection and extensive defects in poorly vascularized transplant sites. No previous description of the long thoracic nerve as a vascularized nerve graft is available. The aim of this study was to demonstrate the anatomic and initial clinical application of such a graft. The long thoracic nerve was dissected in 84 cases to examine its length, diameter, ramification and type of perfusion. On removal of the nerve, adequate perfusion through the thoracodorsal artery and a constant anatomic course with minimal loss of function were found. The long thoracic nerve is accessible anatomically, easily dissected and removed. This may be carried out together with the thoracodorsal vein and artery and even with a pedicled myocutaneous latissimus dorsi transplant, an osseo-myocutaneous scapulo-latissimus dorsi transplant or an osseous scapular transplant. The long thoracic nerve transplant can be employed for extensive facial defects together with simultaneous osseous and myocutaneous transplants of the shoulder region.
带血管神经移植可实现神经缺损的满意功能重建。这些缺损包括创伤性神经切断后的缺损、肿瘤切除术中的医源性切断以及血供较差的移植部位的广泛缺损。目前尚无关于胸长神经作为带血管神经移植物的描述。本研究的目的是展示这种移植物的解剖结构及初步临床应用。对84例患者的胸长神经进行解剖，以检查其长度、直径、分支及灌注类型。在取出神经时，发现通过胸背动脉有充足的灌注，且其解剖走行恒定，功能丧失最小。胸长神经在解剖上易于显露，易于分离和取出。这可以与胸背静脉和动脉一起进行，甚至可以与带蒂肌皮背阔肌移植、骨-肌皮肩胛-背阔肌移植或肩胛骨骨移植一起进行。胸长神经移植可与肩部同时进行的骨和肌皮移植一起用于广泛的面部缺损。
