Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary Hospital, Jubilee Building, 84 Castle Street, Glasgow G4 0SF, UK.
J Plast Reconstr Aesthet Surg. 2010 Jan;63(1):54-8. doi: 10.1016/j.bjps.2008.08.010. Epub 2008 Nov 17.
The present study was conducted to investigate the anatomy of the motor nerve to the gracilis muscle (MNG) to provide the anatomical basis for harvesting a one-stage gracilis transfer with a long nerve for re-animation of the paralysed face.
An anatomical study was performed on 24 lower-limb specimens (from the pelvis down to the knee) from 12 embalmed cadavers. The MNG was dissected from the surface of the muscle to the obturator foramen. Two anatomical regions were defined in the course of the nerve. The first region includes the part of the nerve that can easily be reached through a standard incision in the medial aspect of the thigh, that is, from the surface of the muscle to the posterior border of the adductor brevis muscle and the second region from there to the obturator foramen. Measurements of both anatomical regions and the maximum length of the nerve were taken with a calliper. The anatomical relations of the nerve were also noted and photo-documented.
The median maximum length of the MNG from the surface of gracilis to the posterior border of adductor brevis ('first anatomical region') was 7.7 cm (Range 6.3-10.5 cm); from there to the obturator foramen ('second anatomical region') the length was 3.7 cm (Range 2-6 cm), giving a median length of dissection of the nerve as 11.5 cm (Range 9.9-13.6 cm). Intraneural dissection of the MNG has to be performed proximally in the course of the nerve (the part corresponding to the second anatomical region), just where it runs inside the fascia over the obturator externus muscle.
Over 10-cm length of the MNG can be obtained when dissected along the course of the nerve up to the obturator foramen. To achieve the maximum length, intraneural dissection must normally be performed after the nerve passes the posterior border of the adductor brevis. An endoscopic approach or extended proximal incision is recommended to easily reach the proximal part of the nerve as far as the obturator foramen.
本研究旨在探讨股薄肌运动神经（MNG）的解剖结构，为瘫痪面部的一次性股薄肌转移提供长神经再激活的解剖学基础。
对 12 具防腐尸体的 24 个下肢标本（从骨盆到膝关节）进行解剖学研究。从肌肉表面解剖 MNG 到闭孔。在神经的过程中定义了两个解剖区域。第一区域包括通过大腿内侧标准切口很容易到达的神经部分，即从肌肉表面到短收肌后缘，第二区域从那里到闭孔。用卡尺测量两个解剖区域和神经的最大长度。还记录了神经的解剖关系并拍照记录。
从股薄肌表面到短收肌后缘（“第一解剖区域”）的 MNG 中位数最大长度为 7.7 厘米（范围 6.3-10.5 厘米）；从那里到闭孔的长度为 3.7 厘米（范围 2-6 厘米），神经的中位数解剖长度为 11.5 厘米（范围 9.9-13.6 厘米）。MNG 的神经内解剖必须在神经的行程中近端进行（与第二解剖区域相对应的部分），就在它在闭孔外肌筋膜内运行的地方。
当沿着神经的行程解剖到闭孔时，可以获得超过 10 厘米长的 MNG。为了获得最大长度，神经内解剖通常必须在神经通过短收肌后缘后进行。建议使用内镜方法或延长近端切口，以便轻松到达神经的近端部分，直至闭孔。
