Wu Liza C, Djohan Risal S, Liu Tom S, Chao Albert H, Lohman Robert F, Song David H
Section of Plastic and Reconstructive Surgery, University of Chicago Hospitals, Chicago, IL 60637, USA.
Plast Reconstr Surg. 2006 Jan;117(1):253-8. doi: 10.1097/01.prs.0000185670.15531.50.
A variety of muscle flaps have been described to treat complex groin wounds associated with infected and/or exposed femoral vessels or vascular grafts and persistent lymphatic leaks, and for prophylaxis against wound breakdown following inguinal lymphadenectomy. The sartorius muscle flap has several advantages over other muscle flaps: it is immediately adjacent to the groin, it is easy to prepare, and the harvest causes no functional morbidity. Despite these advantages, the flap's reliability has been questioned because of the segmental blood supply to the muscle and the flap's limited arc of rotation. To improve the reliability of the flap, the authors defined the proximal vascular anatomy of the sartorius muscle in 20 human cadavers and assessed the correlation with 20 clinical cases. They describe a technique for the harvest of the sartorius muscle transposition flap that preserves the most proximal pedicle.
From July of 2000 to January of 2004, 40 sartorius muscles were dissected in 20 human preserved cadavers. During the same time period, 21 sartorius muscle transposition flap procedures were performed in 19 patients for a variety of complex groin wound complications, including infection (n = 10), lymphadenectomy (n = 4), lymphatic leak (n = 3), exposed femoral vessels (n = 3), and high-risk wound (n = 1). The location of the most proximal vascular pedicle with respect to the anterior superior iliac spine was measured in each cadaveric dissection as well as in each clinical case. Outcomes were assessed in the clinical cases with respect to wound healing.
The distance between the anterior superior iliac spine and the proximal vessels in the cadaver specimens was 6.6 +/- 1.3 cm (range, 5.0 to 9.5 cm). The distance between the anterior superior iliac spine and the proximal vessels in the clinical patients was 6.2 +/- 0.6 cm (range, 5.5 to 7.5 cm). Patients were followed for an average period of 30 months (range, 5 to 45 months). There were no incidences of partial or total flap necrosis. All wounds healed to completion.
The proximal pedicle of the sartorius muscle is consistently located at 6.5 cm from the anterior superior iliac spine. Preservation of the proximal pedicle during dissection ensures the viability of the sartorius muscle transposition flap for the treatment of complex groin wounds.
已有多种肌皮瓣被用于治疗与感染和/或暴露的股血管或血管移植物以及持续性淋巴漏相关的复杂腹股沟伤口，以及预防腹股沟淋巴结清扫术后的伤口裂开。缝匠肌皮瓣相对于其他肌皮瓣具有多个优点：它紧邻腹股沟，易于制备，且切取后不会导致功能障碍。尽管有这些优点，但由于该肌皮瓣的节段性血供以及有限的旋转弧度，其可靠性受到质疑。为提高该肌皮瓣的可靠性，作者在20具人体尸体上明确了缝匠肌的近端血管解剖结构，并评估了与20例临床病例的相关性。他们描述了一种保留最近端蒂的缝匠肌转位皮瓣切取技术。
2000年7月至2004年1月，在20具保存的人体尸体上解剖了40条缝匠肌。在同一时期，19例患者因各种复杂的腹股沟伤口并发症接受了21例缝匠肌转位皮瓣手术，包括感染（n = 10）、淋巴结清扫（n = 4）、淋巴漏（n = 3）、股血管暴露（n = 3）和高风险伤口（n = 1）。在每例尸体解剖以及每例临床病例中，测量最近端血管蒂相对于髂前上棘的位置。对临床病例的伤口愈合情况进行评估。
尸体标本中髂前上棘与近端血管之间的距离为6.6±1.3 cm（范围为5.0至9.5 cm）。临床患者中髂前上棘与近端血管之间的距离为6.2±0.6 cm（范围为5.5至7.5 cm）。患者平均随访30个月（范围为5至45个月）。未发生部分或全部皮瓣坏死。所有伤口均完全愈合。
缝匠肌的近端蒂始终位于距髂前上棘6.5 cm处。解剖过程中保留近端蒂可确保缝匠肌转位皮瓣用于治疗复杂腹股沟伤口时的存活能力。
