Casey William J, Rebecca Alanna M, Smith Anthony A, Craft Randall O, Hayden Richard E, Buchel Edward W
Scottsdale, Ariz.; and Manitoba, Winnipeg, Canada From the Division of Plastic and Reconstructive Surgery and Departments of General Surgery and Otolaryngology, Mayo Clinic Scottsdale, and Section of Plastic and Reconstructive Surgery, University of Manitoba.
Plast Reconstr Surg. 2007 Jul;120(1):196-201. doi: 10.1097/01.prs.0000264098.05399.6a.
The vascular anatomy of the anterolateral thigh flap has been well studied, but no study has evaluated the effect of the vastus lateralis motor nerve anatomy on anterolateral thigh flap harvest.
A retrospective review was performed of all anterolateral thigh flaps from January of 2003 through December of 2004. Information regarding the motor nerve to the vastus lateralis muscle was recorded, along with its influence on anterolateral thigh flap harvest.
Forty-three anterolateral thigh flap procedures were performed over a 2-year period. In three cases (7 percent), the course of the motor nerve to the vastus lateralis resulted in a significant modification in anterolateral thigh flap harvest. In one case, the motor nerve passed between the venae comitantes of the descending branch of the lateral femoral circumflex artery just proximal to the midperforator origin. In two cases, large skin islands were raised with two perforators included in each flap. The motor nerve passed between the two perforators in these cases.
Two patterns of vastus lateralis motor nerve anatomy can adversely influence anterolateral thigh flap elevation. One involves the motor nerve passing through the main vascular pedicle. The other occurs when multiple perforators are required to support large flaps with the motor nerve passing between these perforators. In some cases, the course of the nerve may require transection of the nerve, with a subsequent deficit in vastus lateralis function. In similar cases, if the nerve is preserved, the vascular pedicle may require significant modification, which may possibly compromise flap perfusion.
股前外侧皮瓣的血管解剖已得到充分研究，但尚无研究评估股外侧肌运动神经解剖对股前外侧皮瓣切取的影响。
对2003年1月至2004年12月期间所有股前外侧皮瓣进行回顾性研究。记录有关股外侧肌运动神经的信息及其对股前外侧皮瓣切取的影响。
在2年期间共进行了43例股前外侧皮瓣手术。在3例（7%）中，股外侧肌运动神经的走行导致股前外侧皮瓣切取有显著改变。1例中，运动神经在旋股外侧动脉降支伴行静脉之间、恰在穿支起点近端通过。2例中，掀起了大的皮岛，每个皮瓣包含两个穿支。在这些病例中，运动神经在两个穿支之间通过。
股外侧肌运动神经解剖的两种模式可对股前外侧皮瓣掀起产生不利影响。一种是运动神经穿过主要血管蒂。另一种是当需要多个穿支来支持大皮瓣且运动神经在这些穿支之间通过时发生。在某些情况下，神经走行可能需要切断神经，随后股外侧肌功能出现缺损。在类似病例中，如果保留神经，血管蒂可能需要显著改变，这可能会损害皮瓣灌注。
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