Elbarrany W G, Al-Hayani Abdulmonem, Softa S
Department of Anatomy, Faculty of Medicine, Umm Al-Qura University, Makkah Almokarramah, Kingdom of Saudi Arabia
West Afr J Med. 2005 Oct-Dec;24(4):287-94. doi: 10.4314/wajm.v24i4.28196.
Dynamic graciloplasty is used commonly as a neoanal sphincter to reconstruct the damaged anal sphincter. However, infection of the transposed gracilis and consequent failure of anal reconstruction has been recorded in some cases. An alternative to gracilis muscle should be searched for to reconstruct and replace the anal sphincter.
30 fresh cadavers (20 adult, 10 stillborns) had been used in this study.
The external and common iliac arteries were injected with a mixture of 50% lead oxide and 50% red latex. The long head of biceps femoris was exposed to identify its neurovascular bundle and estimate the whole length of the thigh, the whole length of the long head of biceps and the dominant neurovascular pedicles of the long head of biceps muscle. The functional length of the biceps muscle that is used during the muscle rotation was also calculated. The diameter of the arteries supplying the muscle was measured at their proximal and distal ends using a Swiss mechanic caliber. The thighs of both sides of each cadaver were X-rayed in order to study the vascular architecture of the muscle, and then the biceps muscle was dissected and removed then X-rayed to study the internal vasculature and anastomosis.
The study showed that there were four dominant arterial pedicles to the long head of biceps femoris muscle in addition to several minor arterial branches in 90% of the studied cases. In all cases, the inferior gluteal artery gave one major arterial pedicle to the proximal end of the muscle. The radiological study of the vasculature of the long head of biceps muscle during the current study showed the presence of anastomosing arterial loops between the internal iliac, external iliac, femoral and profunda femoris arteries. It also showed the presence of extensive intramuscular anastomosis between the intramuscular branches of the major arterial pedicles inside the long head of biceps femoris muscle. During the present study, it was found that the muscle received a single nerve supply in 97% of the dissected cadavers. This means that about in 58% of the cases, the muscle is available for transposition to wrap the anal canal. The available length of the muscle for rotation was about 57% of the length of the thigh.
It can be concluded that, the long head of the biceps muscle can be safely rotated to wrap around the anal canal without serious effect on the main vascular pedicles and its nerve supply.
动态股薄肌成形术通常用作新肛门括约肌来重建受损的肛门括约肌。然而，在一些病例中已记录到移植的股薄肌感染及随之而来的肛门重建失败。应寻找股薄肌的替代物来重建和替代肛门括约肌。
本研究使用了30具新鲜尸体（20具成人尸体，10具死产儿尸体）。
向髂外动脉和髂总动脉注入50%氧化铅与50%红色乳胶的混合物。暴露股二头肌长头以识别其神经血管束，并测量大腿全长、股二头肌长头全长以及股二头肌长头的主要神经血管蒂。还计算了肌肉旋转过程中使用的股二头肌的功能长度。使用瑞士机械卡尺在供应肌肉的动脉近端和远端测量其直径。对每具尸体两侧大腿进行X线检查以研究肌肉的血管结构，然后解剖并移除股二头肌后进行X线检查以研究内部血管系统和吻合情况。
研究表明，在90%的研究病例中，除了几条小动脉分支外，股二头肌长头有四条主要动脉蒂。在所有病例中，臀下动脉向肌肉近端发出一条主要动脉蒂。本次研究中对股二头肌长头血管系统的放射学研究显示，髂内动脉、髂外动脉、股动脉和股深动脉之间存在吻合动脉环。还显示股二头肌长头内部主要动脉蒂的肌内分支之间存在广泛的肌内吻合。在本次研究中，发现97%的解剖尸体中该肌肉接受单一神经支配。这意味着约58%的病例中，该肌肉可用于移位以包裹肛管。可用于旋转的肌肉长度约为大腿长度的57%。
可以得出结论，股二头肌长头可以安全地旋转以包裹肛管，而不会对主要血管蒂及其神经支配产生严重影响。
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