Bardoel J W, Stadelmann W K, Tobin G R, Werker P M, Stremel R W, Kon M, Barker J H
Department of Surgery, School of Medicine, University of Louisville, KY, USA.
Plast Reconstr Surg. 2000 Feb;105(2):589-95. doi: 10.1097/00006534-200002000-00017.
Permanent fecal abdominal stomas significantly decrease quality of life. Previous attempts to create continent stomas by using dynamic myoplasty procedures have resulted in disappointing outcomes, primarily owing to denervation atrophy of the muscle flap that was used in the creation of the sphincter and because of muscle fatigue resulting from continuous electrical stimulation that is received by the flap to force contraction. On the basis of these problems, we designed two separate studies: an anatomical study addressing flap denervation and a functional study addressing muscle fatigue. The present study addresses the first topic and was designed to develop a rectus abdominis muscle flap into a sphincter that was anatomically situated to create a stoma while preserving as much innervation as possible. In 24 rectus abdominis muscles of human cadavers, the neurovascular anatomy was defined, then the anatomical feasibility of two different muscle flap configurations was considered. The flaps investigated were the peninsula flap and island flap designs, with both using the most caudal segment of the rectus abdominis muscle in construction of the sphincter. Neither flap design required the killing of a nerve for stoma sphincter creation, resulting in minimal muscle denervation. The conclusion of our comparison was that the above, in conjunction with other features of the island flap design, such as muscle overlap after sphincter formation and abdominal wall positioning of the sphincter, made the island flap design better suited to stoma sphincter construction.
永久性粪便腹壁造口显著降低生活质量。以往尝试通过动态肌成形术创建可控造口，结果令人失望，主要原因是用于构建括约肌的肌瓣去神经萎缩，以及肌瓣因持续电刺激以强制收缩而导致的肌肉疲劳。基于这些问题，我们设计了两项独立研究：一项解剖学研究探讨肌瓣去神经问题，另一项功能研究探讨肌肉疲劳问题。本研究关注第一个主题，旨在将腹直肌肌瓣发育成解剖位置合适的括约肌以创建造口，同时尽可能保留神经支配。在24具人类尸体的腹直肌中，明确了神经血管解剖结构，然后考虑了两种不同肌瓣构型的解剖可行性。所研究的肌瓣为半岛瓣和岛状瓣设计，二者在构建括约肌时均使用腹直肌最尾端部分。两种瓣设计在创建造口括约肌时均无需切断神经，从而使肌肉去神经支配降至最低。我们比较的结论是，上述情况连同岛状瓣设计的其他特征，如括约肌形成后的肌肉重叠以及括约肌在腹壁的定位，使岛状瓣设计更适合造口括约肌构建。
