Taylor G Ian, Cichowitz Adam, Ang Soon Ghee, Seneviratne Sugitha, Ashton Mark
Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Royal Melbourne Hospital, Australia.
Plast Reconstr Surg. 2003 Jul;112(1):20-30. doi: 10.1097/01.PRS.0000065909.86735.F7.
Since the introduction of cross-facial nerve grafting and free vascularized muscle transfer for the treatment of longstanding facial paralysis, substantial progress has been made toward restoration of facial expression that is as normal as possible. Much of the focus has remained on the gracilis as a donor muscle. However, its inherent anatomical characteristics may preclude it from ever being more than simply a mass of contractile tissue in the face. The coracobrachialis muscle, which is the analogue in the arm of the lower limb adductor mass, was proposed as an alternative donor muscle because it was thought that certain features would allow it to improve on the overall results that are currently possible with the gracilis. A comparative anatomical study was conducted to gauge this potential. A total of 133 muscles were analyzed, including 96 dissected specimens, 16 arterial and 14 venous study specimens, and seven neurovascular study specimens. Anatomical parameters were recorded for each muscle and later tabulated. Histological analysis of the nerves to 10 gracilis and 10 coracobrachialis muscles was performed, and the findings were confirmed with intraneural dissection of an additional 20 nerves under an operating microscope. The coracobrachialis was observed to be a practical alternative to the gracilis. Indeed, it has many of the attributes that initially drew attention to the gracilis as a possible donor muscle, including a reliable neurovascular supply, minimal donor-site morbidity, and the option of having two teams operate simultaneously. In addition, it has a size, shape, and form that make it an excellent choice for transfer to the face. It could be easily attached in the face to provide static support as well as animation, because of its long proximal tendon, the thick intermuscular septum along its lateral surface, and, when present, the ligament of Struthers.
自从采用跨面神经移植和游离带血管肌肉移植治疗长期面瘫以来，在尽可能恢复正常面部表情方面已取得了重大进展。大部分注意力一直集中在股薄肌作为供体肌肉上。然而，其固有的解剖学特征可能使其永远只能成为面部一块简单的收缩组织。肱二头肌是上肢内收肌群在手臂中的对应肌肉，被提议作为替代供体肌肉，因为人们认为其某些特征将使其能够改善目前使用股薄肌所能取得的总体效果。进行了一项比较解剖学研究来评估这种潜力。共分析了133块肌肉，包括96个解剖标本、16个动脉和14个静脉研究标本以及7个神经血管研究标本。记录了每块肌肉的解剖参数，随后制成表格。对10块股薄肌和10块肱二头肌的神经进行了组织学分析，并在手术显微镜下对另外20条神经进行神经内解剖以证实研究结果。观察到肱二头肌是股薄肌的一种实用替代物。实际上，它具有许多最初使股薄肌成为可能的供体肌肉而受到关注的特性，包括可靠的神经血管供应、供体部位发病率低以及可选择两个手术团队同时进行手术。此外，它的大小、形状和形态使其成为转移至面部的绝佳选择。由于其近端肌腱长、外侧表面有厚厚的肌间隔，以及（若存在）Struthers韧带，它可以很容易地附着在面部以提供静态支撑和动态表情。
