Becker M H, Wermter T B, Brenner B, Walter G F, Berger A
Clinic of Plastic, Hand, and Reconstructive Surgery, Medical School Hannover, Germany.
J Reconstr Microsurg. 2000 Oct;16(7):525-34. doi: 10.1055/s-2000-8390.
The aim of this study was to obtain further insights about muscle regeneration processes in free neurovascular flaps. In cases of insufficient functional return of muscle strength, several factors, such as diminished axonal ingrowth, fatty degeneration, or connective tissue proliferation are discussed. In the study, free neurovascular latissimus dorsi (LD) flaps were examined after a regeneration period of 2 to 6 years. Clinical function (M1 to M4) and histopathologic characteristics of the muscle grafts were correlated. The rare instances of secondary procedures, such as tenolysis or scar correction, were used for biopsies of the muscle graft. Free neurovascular LD flaps were examined after a regeneration period between 2 and 6 years. The grafted LD was compared to normal, healthy LD muscle. Normal LD muscle showed a typical homogeneous pattern of types 1 and 2 fibers in a ratio of almost 1:1. No significant differences concerning fiber distribution and fiber diameters in three anatomic areas of the LD (proximal, medial, caudal) could be detected. After regeneration, the authors found the following: type grouping of muscle fiber types, fiber splitting, and groups of hypertrophic and atrophic fibers. Most of the muscle fibers were not reinnervated by axons and were atrophic or degenerated. The essential proliferation of connective and fatty tissue was absent. Normal and hypertrophic fibers were found mainly in the muscle grafts with good clinical results. In muscle grafts with good contraction force (M4), 46 percent of reinnervated muscle fibers were found; M3 contractility was correlated with 31 percent of reinnervated muscle fibers; M2 with 24 percent; and M1 with 21 percent of reinnervated fibers. The force of a free muscle graft seems to depend mainly on the quality of nerve regeneration. Characteristics of the muscle fiber itself were not examined extensively, because the single-fiber contractility of the regenerated fibers was similar to the contractility of normal, healthy fibers.
本研究的目的是进一步深入了解游离神经血管皮瓣中的肌肉再生过程。在肌肉力量功能恢复不足的情况下，会讨论多种因素，如轴突长入减少、脂肪变性或结缔组织增生。在该研究中，对游离神经血管背阔肌（LD）皮瓣在2至6年的再生期后进行了检查。将肌肉移植物的临床功能（M1至M4）与组织病理学特征进行了关联分析。罕见的二次手术病例，如肌腱松解术或瘢痕矫正术，被用于获取肌肉移植物的活检样本。对游离神经血管LD皮瓣在2至6年的再生期后进行了检查。将移植的LD与正常、健康的LD肌肉进行了比较。正常LD肌肉显示出典型的1型和2型纤维均匀分布模式，比例几乎为1:1。在LD的三个解剖区域（近端、内侧、尾端）未检测到纤维分布和纤维直径的显著差异。再生后，作者发现了以下情况：肌纤维类型分组、纤维分裂以及肥大和萎缩纤维群。大多数肌纤维未被轴突重新支配，处于萎缩或退化状态。结缔组织和脂肪组织未出现明显增生。正常和肥大的纤维主要存在于临床效果良好的肌肉移植物中。在收缩力良好（M4）的肌肉移植物中，发现46%的肌纤维被重新支配；M3收缩力与31%的重新支配肌纤维相关；M2与24%相关；M1与21%的重新支配纤维相关。游离肌肉移植物的力量似乎主要取决于神经再生的质量。由于再生纤维的单纤维收缩力与正常、健康纤维的收缩力相似，因此未对肌纤维本身的特征进行广泛研究。
