Rozen Warren M, le Roux Cara Michelle, Ashton Mark W, Grinsell Damien
Parkville, Victoria, Australia From the Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, University of Melbourne.
Plast Reconstr Surg. 2009 May;123(5):1505-1509. doi: 10.1097/PRS.0b013e3181a0748a.
The anterolateral thigh flap is a popular reconstructive option, with a major advantage being its low donor-site morbidity. However, donor-site morbidity following anterolateral thigh flap harvest does occur, with postulated causes including damage to muscle, deep fascia, and the motor nerves to the vastus lateralis. No anatomical studies have yet described the relationship of these motor nerves to the vascular pedicle of the anterolateral thigh flap.
Thirty-six human cadaveric thighs underwent dissection studies, and the innervation of the vastus lateralis and the relationship of the nerves to the descending branch of the lateral circumflex femoral artery were documented. Variations were recorded.
The nerve to the vastus lateralis branches extensively before entering the muscle, with four to seven nerves identified per thigh. Two particular variations of the nerve anatomy are uniquely susceptible to damage: where the motor nerve passes through the vascular pedicle itself or passes between perforators supplying the flap. At least one unfavorable variation was present in 28 percent of cases.
The nerves innervating the vastus lateralis are intimately related to the vascular pedicle of the anterolateral thigh flap. These nerves may be damaged during flap harvest and may contribute to donor-site morbidity after anterolateral thigh flap surgery.
股前外侧皮瓣是一种常用的重建选择，其主要优点是供区并发症发生率低。然而，切取股前外侧皮瓣后确实会发生供区并发症，推测的原因包括肌肉、深筋膜以及股外侧肌运动神经的损伤。尚无解剖学研究描述这些运动神经与股前外侧皮瓣血管蒂的关系。
对36具人尸体大腿进行解剖研究，记录股外侧肌的神经支配以及神经与旋股外侧动脉降支的关系。记录变异情况。
股外侧肌神经在进入肌肉前广泛分支，每侧大腿可识别出4至7条神经。神经解剖结构有两种特殊变异特别容易受损：运动神经穿过血管蒂本身或在供应皮瓣的穿支之间穿过。28%的病例中至少存在一种不利变异。
支配股外侧肌的神经与股前外侧皮瓣的血管蒂密切相关。这些神经在切取皮瓣过程中可能受损，并可能导致股前外侧皮瓣手术后的供区并发症。
