Karakawa Ryo, Yoshimatsu Hidehiko, Fuse Yuma, Hayashi Akitatsu, Tanakura Kenta, Heber Ulrike M, Weninger Wolfgang J, Tzou Chieh-Han J, Meng Stefan, Yano Tomoyuki
Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan.
Microsurgery. 2020 Feb;40(2):200-206. doi: 10.1002/micr.30517. Epub 2019 Oct 8.
The profunda femoris artery perforator (PAP) flap is gaining popularity in microsurgical reconstruction. To establish a safer flap elevation technique, we focused on the topology of the accessory saphenous vein in the medial thigh area. We hypothesize that including the accessory saphenous vein in a PAP flap results in safer PAP flap transfer with two venous drainage systems. The aim of this study was to describe the anatomical relationship between the perforators and the accessory saphenous vein in the PAP flap using fresh cadavers and to describe the relationship through two clinical cases.
For the anatomical study, 19 posterior medial thigh regions from 10 fresh cadavers were dissected. We recorded the number, site of origin, the length, and the diameter of the pedicle. We also documented the course, the length, and the diameter of the accessory saphenous vein. PAP flap transfer with additional accessory saphenous vein anastomosis was performed in two clinical cases; a 40-year-old female with tongue cancer and a 51-year-old female with breast cancer.
In all cadaveric specimens, the accessory saphenous vein was found above the deep fascia. The average distance between the proximal thigh crease and the intersection of the anterior edge of the gracilis muscle and the accessory saphenous vein was 7.7 ± 2.5 cm. The diameter of the accessory saphenous vein averaged 3.1 ± 1.1 mm. The average accessory saphenous vein length from its takeoff from the great saphenous vein to the anterior edge of the gracilis muscle was 4.2 ± 1.3 cm. In clinical cases, the flap size was 6 x 18 cm and 8 x 21 cm and the follow-up length was 12 and 3 months, respectively. In both cases, the postoperative course was uneventful and the flap survived completely.
Anatomical study confirmed that the accessory saphenous vein did exist in all specimens and it could be included in the PAP flap with sufficient length and relatively large diameter. Although further clinical investigation will be required to confirm its efficacy, a PAP flap including the accessory saphenous vein may decrease the chances of flap congestion.
股深动脉穿支（PAP）皮瓣在显微外科重建中越来越受欢迎。为建立一种更安全的皮瓣掀起技术，我们关注大腿内侧区域的副隐静脉的拓扑结构。我们假设在PAP皮瓣中纳入副隐静脉可通过两个静脉引流系统实现更安全的PAP皮瓣转移。本研究的目的是使用新鲜尸体描述PAP皮瓣中穿支与副隐静脉之间的解剖关系，并通过两个临床病例描述这种关系。
对于解剖学研究，对10具新鲜尸体的19个大腿后内侧区域进行了解剖。我们记录了穿支的数量、起源部位、蒂的长度和直径。我们还记录了副隐静脉的走行、长度和直径。在两个临床病例中进行了带有额外副隐静脉吻合的PAP皮瓣转移；一名40岁舌癌女性和一名51岁乳腺癌女性。
在所有尸体标本中，副隐静脉均位于深筋膜上方。大腿近端皱襞与股薄肌前缘与副隐静脉交点之间的平均距离为7.7±2.5厘米。副隐静脉的平均直径为3.1±1.1毫米。副隐静脉从大隐静脉起始处到大收肌前缘的平均长度为4.2±1.3厘米。在临床病例中，皮瓣大小分别为6×18厘米和8×21厘米，随访时间分别为12个月和3个月。在这两个病例中，术后过程均顺利，皮瓣完全存活。
解剖学研究证实所有标本中均存在副隐静脉，且其可被纳入PAP皮瓣，长度足够且直径相对较大。尽管需要进一步的临床研究来证实其疗效，但包含副隐静脉的PAP皮瓣可能会降低皮瓣充血的几率。
