Hurwitz Zachary M, Montilla Richard, Dunn Raymond M, Patel Neil V, Akyurek Mustafa
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Ann Plast Surg. 2011 May;66(5):438-43. doi: 10.1097/SAP.0b013e3182185ee1.
The adductor magnus musculocutaneous perforator flap is a medial thigh flap whose utility is often overshadowed by that of its anatomic neighbor, the gracilis flap. It has a large, reliable pedicle and associated skin paddle. Few reports have been published describing the use of this flap as a local or free tissue transfer. The purpose of this study is to revisit and further characterize the anatomy of this extremely versatile yet underutilized flap.
MATERIALS/METHODS: A total of 13 cadavers (n = 26 thighs) were dissected to identify the musculocutaneous perforators that supply the skin of the posteriomedial thigh. The vascular anatomy was studied using multiple modalities. Based on the anatomic data, a local V-Y advancement flap was designed. A total of 8 patients (n = 10 flaps) underwent reconstruction of locoregional defects.
Our anatomic studies confirmed the presence of multiple parallel musculocutaneous perforators that travel through the adductor magnus muscle and course obliquely in a posterior-inferior direction. We found that the primary perforator is reliably found approximately 8 cm distal to the groin crease and 2 cm posterior to the posterior border of the gracilis muscle. We discovered that it is consistently accompanied by a separate perforator located 2 cm distally. Minimal dissection into the muscle revealed a Y-configuration of these 2 perforators. This configuration was present in 100% of the cadaveric dissections and is supplied by the first medial branch of the profunda femoris artery. Computed tomography angiograms depicted vascular arborization of the perforators supplying the flap. Clinical experience showed that complete flap survival was achieved in all of the cases.
The adductor magnus perforator flap is a reliable flap that offers robust blood supply, through a consistent vascular pedicle, to an extensive skin territory. Our anatomic studies revealed the consistent presence of 2 proximal perforators in the medial thigh that are linked by an intramuscular Y-configuration that provides enhanced blood supply to a local V-Y advancement flap design. The location of the skin paddle on the proximal medial thigh allows for minimal donor-site morbidity as it can be closed primarily with a V-Y advancement flap design, obviating the need for skin grafting.
大收肌肌皮穿支皮瓣是一种大腿内侧皮瓣，其应用价值常被其解剖学邻位的股薄肌皮瓣所掩盖。它有一个粗大、可靠的蒂和相连的皮瓣。很少有报道描述该皮瓣作为局部或游离组织转移的应用。本研究的目的是重新审视并进一步描述这种用途极为广泛但未得到充分利用的皮瓣的解剖结构。
材料/方法：共解剖了13具尸体（26条大腿），以确定供应大腿后内侧皮肤的肌皮穿支。使用多种方法研究血管解剖结构。基于解剖学数据，设计了一种局部V-Y推进皮瓣。共有8例患者（10个皮瓣）接受了局部缺损的修复。
我们的解剖学研究证实存在多条平行的肌皮穿支，它们穿过大收肌并向后下斜行。我们发现主要穿支在腹股沟皱襞远端约8 cm、股薄肌后缘后方2 cm处可可靠找到。我们发现它始终伴有一个位于其远端2 cm处的独立穿支。对肌肉进行最小程度的解剖可发现这两个穿支呈Y形结构。这种结构在所有尸体解剖中均存在，由股深动脉的第一内侧分支供血。计算机断层血管造影显示了供应皮瓣的穿支的血管分支情况。临床经验表明所有病例皮瓣均完全存活。
大收肌穿支皮瓣是一种可靠的皮瓣，通过一致的血管蒂为广泛的皮肤区域提供充足的血液供应。我们的解剖学研究揭示大腿内侧始终存在两个近端穿支，它们通过肌肉内的Y形结构相连，为局部V-Y推进皮瓣设计提供了增强的血液供应。皮瓣位于大腿近端内侧，由于可采用V-Y推进皮瓣设计直接闭合供区，无需植皮，从而使供区并发症降至最低。
