Carney Martin J, Matatov Tim, Freeman Matthew, Miller John, Vemula Rahul, Schuster Jason, Dancisak Michael, Lindsey John, Rae Guenevere
From the *Tulane University School of Medicine, †Division of Plastic Surgery, Tulane University School of Medicine, New Orleans, LA; ‡Division of Plastic Surgery, Mount Sinai Hospital, New York, NY; §Louisiana State University Health Sciences Center; ∥Center for Anatomical and Movement Sciences, Tulane University; and ¶Department of Cell Biology and Anatomy, Louisiana State University Health Sciences Center, New Orleans, LA.
Ann Plast Surg. 2017 Jun;78(6S Suppl 5):S305-S310. doi: 10.1097/SAP.0000000000001033.
The medial thighplasty is a procedure where patients may attain superior mobility, hygiene, and cosmesis. Most surgeons use attachment of the superficial fascial system (SFS) of the thigh flap to the Colles fascia, whereas others attach the SFS to the pubic ramus periosteum. Because of a high complication profile, we aim to elucidate the clinical, biomechanical, and anatomic qualities of the Colles fascia versus the pubic ramus periosteum.
We performed a 17-year retrospective review documenting clinical complications, a biomechanical analysis of sutures placed in different tissue layers of the thigh, and a histologic analysis surrounding the ischiopubic ramus. Separate suture pull-out strength testing was conducted on cadaveric tissue using an Admet MTEST Quattro with no. 1 Vicryl suture and tissue grips at a displacement rate of 2.12 mm/s. Simultaneous displacement and force were acquired at 100 Hz and with measurements obtained at regular intervals between the pubic symphysis and the ischial tuberosity in both the Colles fascia and the deeper periosteal layers of the thigh. A histologic analysis was performed at 3 points along the ischiopubic ramus using paraffin-embedded large mount tissue sections stained with hematoxylin, eosin, and Gomori trichrome.
Thirty-nine patients underwent medial thighplasty with a 46.16% complication rate. Suture pull-out force of the suspected superficial Colles fascia sites was, on average, 72.8% less than values from the deeper periosteum tissue. Anchor points in the Colles fascia elongated 17.4% further before failure than those in the periosteum. There was noticeable variability between anchor points and across samples. The histologic sections suggest that the Colles fascia from the different regions of the ischiopubic ramus varies considerably in both continuity and collagen fiber content with no discernible pattern. The periosteal and muscular fascial layers were more continuous histologically with direct attachments into the pubis and ischium.
Anchoring of the SFS to the periosteum did not improve our complication profile when compared with the literature. Both the biomechanical and histologic analyses demonstrate that the Colles fascia is highly variable in organizations with coincident variability in tissue strength. Our results require further study to identify the optimal surgical technique for medial thighplasty.
内侧大腿成形术是一种可使患者获得更好的活动能力、卫生状况和美观效果的手术。大多数外科医生将大腿皮瓣的浅筋膜系统（SFS）附着于Colles筋膜，而其他医生则将SFS附着于耻骨支骨膜。由于并发症发生率较高，我们旨在阐明Colles筋膜与耻骨支骨膜的临床、生物力学和解剖学特性。
我们进行了一项为期17年的回顾性研究，记录临床并发症，对大腿不同组织层放置的缝线进行生物力学分析，并对坐骨耻骨支周围进行组织学分析。使用Admet MTEST Quattro对尸体组织进行单独的缝线拔出强度测试，使用1号薇乔缝线和组织夹具，位移速率为2.12毫米/秒。在100赫兹下同时获取位移和力，并在耻骨联合和坐骨结节之间的Colles筋膜和大腿更深的骨膜层定期进行测量。使用苏木精、伊红和Gomori三色染色的石蜡包埋大切片组织在坐骨耻骨支的3个点进行组织学分析。
39例患者接受了内侧大腿成形术，并发症发生率为46.16%。疑似浅Colles筋膜部位的缝线拔出力平均比深层骨膜组织的值低72.8%。Colles筋膜中的固定点在失效前比骨膜中的固定点伸长了17.4%。固定点之间和样本之间存在明显差异。组织学切片表明，坐骨耻骨支不同区域的Colles筋膜在连续性和胶原纤维含量方面差异很大，没有明显的模式。骨膜层和肌肉筋膜层在组织学上更连续，直接附着于耻骨和坐骨。
与文献相比，将SFS固定于骨膜并没有改善我们的并发症情况。生物力学和组织学分析均表明，Colles筋膜在组织结构上高度可变，组织强度也随之变化。我们的结果需要进一步研究，以确定内侧大腿成形术的最佳手术技术。
