Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Room E533, Department of Anatomy and Cell Biology, University of Melbourne, Grattan Street, Parkville, 3050 Victoria, Australia.
J Plast Reconstr Aesthet Surg. 2010 May;63(5):826-31. doi: 10.1016/j.bjps.2009.02.060. Epub 2009 Apr 26.
The pudendal thigh fasciocutaneous (PTF) flap is a useful flap in perineal reconstruction, that is reliable when small but is traditionally unreliable when large flaps are raised. Large flaps in particular, are associated with an increased incidence of apical necrosis. Thorough descriptions of the vascular anatomy of this flap have been lacking from the literature, with the current study evaluating this anatomy, aiming to provide the anatomical basis for vascular problems and for techniques to maximise its survival.
Five unembalmed human cadaveric pelvis specimens were studied. Lead oxide injectant enabled radiographic and dissection analysis of the arterial anatomy of the integument of the perineum.
A consistent pattern of vascular supply was found in all specimens. 1: the blood supply to the pelvic floor was supplied sequentially by the posterior labial/scrotal arteries, cutaneous branches from the anterior branch of the obturator artery, and branches from the external pudendal arteries. 2: these vessels ran close to the midline, medial to the PTF flap. 3: the posterior labial/scrotal arteries were deep to the Colles' fascia and the branches from the obturator artery and external pudendal arteries were located superficial to the Colles' fascia.
This study has demonstrated that the PTF flap is a three vascular territory flap and that the pedicle is situated close to the midline. This may explain why regions of the PTF flap may have a potentially precarious blood supply, and suggests that the PTF flap should be designed more medially. Given the third territory of supply to the apex of the flap, a delay procedure may help to avoid flap necrosis.
阴部股前筋膜皮瓣（PTF）是会阴重建中一种有用的皮瓣，当皮瓣较小时可靠，但当皮瓣较大时传统上不可靠。特别是较大的皮瓣与顶端坏死的发生率增加有关。该皮瓣的血管解剖结构在文献中描述不充分，本研究评估了该解剖结构，旨在为血管问题和最大限度提高其存活率的技术提供解剖学基础。
研究了 5 具未经防腐处理的人体骨盆标本。氧化铅注射剂使会阴皮肤的动脉解剖结构能够进行放射性和解剖分析。
所有标本均发现一致的血管供应模式。1：骨盆底部的血液供应由阴部后阴唇/阴囊动脉、闭孔动脉前分支的皮肤分支和阴部外动脉分支依次供应。2：这些血管靠近中线，位于 PTF 皮瓣的内侧。3：阴部后阴唇/阴囊动脉位于科雷氏筋膜深面，闭孔动脉和阴部外动脉分支位于科雷氏筋膜浅面。
本研究表明，PTF 皮瓣是一个三血管区域皮瓣，蒂位于中线附近。这可能解释了 PTF 皮瓣为什么可能存在潜在的不稳定的血液供应，并表明 PTF 皮瓣应更靠近中线设计。鉴于皮瓣顶端的第三个供应区域，可以采用延迟程序来帮助避免皮瓣坏死。
