Department of Plastic Surgery, Reconstructive and Hand Surgery, Burn Center, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Gynecol Oncol. 2010 Dec;119(3):526-30. doi: 10.1016/j.ygyno.2010.08.033. Epub 2010 Sep 24.
Vulvar reconstruction following oncologic resection is challenging. Some flaps used for reconstruction can show adverse characteristics such as excessive tissue bulk or increased distance to the defect. Region of the sulcus genitofemoralis is of thin and pliable tissue proximate to the vulva. Vasculature and suitability of that region used for vulvar reconstruction were focused in this work.
Vascular architecture of the region comprising the sulcus genitofemoralis was examined bilaterally on 10 female corpses (n = 20 specimens). In addition, tissue characteristics and suitability of that region to form a fasciocutaneous flap for vulvar reconstruction were anatomically examined and clinically proven.
Vasculature of the sulcus genitofemoralis is reflected by either a musculocutaneous perforator (80%, 16/20) piercing the gracilis muscle or a septocutaneous perforator (20%, 4/20) passing the posterior border of the gracilis muscle 1.3 ± 0.3 [cm] laterally to the inferior pubic ramus. Both types of perforators derive from the anterior branch of the obturator artery and accompanying vein. This perforator, the anterior obturator artery perforator (aOAP), supplies a skin territory of about 7 × 15 [cm] centered on the sulcus genitofemoralis. The aOAP flap proved its suitability and versatility for vulvar reconstruction.
The sulcus genitofemoralis is of a constant vascular anatomy reflected by the aOAP vessel. Especially the tunneled aOAP island flap offers outstanding characteristics beneficial for reconstruction of a more anatomically normal vulva. Scars are limited within anatomic borders of the urogenital region improving self-image. The aOAP flap clearly enlarges the surgical options available to restore the form and function of the vulva.
外阴肿瘤切除术后的重建极具挑战性。一些用于重建的皮瓣可能会表现出一些不良特征，如组织体积过大或与缺损部位的距离增加。股间沟区域的组织薄且有弹性，紧邻外阴。本研究重点关注该区域的血管分布及其用于外阴重建的适宜性。
对 10 具女性尸体（n=20 个标本）的双侧股间沟区域血管结构进行了检查。此外，还对该区域的组织特征及其形成用于外阴重建的筋膜皮瓣的适宜性进行了解剖学检查和临床验证。
股间沟的血管分布由穿经股薄肌的肌皮穿支（80%，16/20）或穿过后侧股薄肌的皮穿支（20%，4/20）来反映，这两种穿支均来自闭孔动脉的前支及其伴行静脉。这两种类型的穿支都供应位于股间沟中心的约 7×15cm 的皮肤区域。该穿支即前闭孔动脉穿支（aOAP），为外阴重建提供了适宜性和多功能性。
股间沟的恒定血管解剖结构由 aOAP 血管反映。特别是隧道式的 aOAP 岛状皮瓣具有出色的特征，有利于重建更具解剖学正常的外阴。切口疤痕限制在泌尿生殖区域的解剖边界内，可改善患者的自我形象。aOAP 皮瓣明显扩大了恢复外阴形态和功能的手术选择。
