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带血管蒂阔筋膜游离皮瓣:解剖学研究与临床考虑。

The vascularized fascia lata free flap: an anatomical study and clinical considerations.

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria.

Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.

出版信息

Eur Arch Otorhinolaryngol. 2020 Jun;277(6):1733-1739. doi: 10.1007/s00405-020-05861-8. Epub 2020 Feb 25.

Abstract

PURPOSE

Fascia lata (FL) is often used as fascial component of the anterolateral thigh (ALT) flap in head and neck reconstruction. No distinct data exist on whether the FL has its own reliable vascular supply and whether the fascia alone can be harvested as a fascia lata free flap.

METHODS

We dissected 25 thighs of 15 cadavers. The lateral circumflex femoral artery (LCFA) was identified, and the size of stained fascia and skin were measured after injection of methylene blue into the descending branch (DB). Finally, topography of fascial vessels was determined.

RESULTS

Staining of fascia and skin paddle was found in all 25 cases. Ascending skin perforators of the DB of the LCFA gave off branches for supply of the FL enabling harvest of a fascia lata free flap. Septo- or musculocutaneous perforators pierced FL and entered skin within the proximal 38.6-60% of the thigh. The mean length and width of stained FL was 15.8 ± 4.1 cm and 8.7 ± 2.0 cm, respectively, and size of stained FL ranged from 40.0 to 336.0 cm. In 20 cases (80%), skin paddles were 2.4 times larger on average compared to corresponding FL.

CONCLUSION

We could demonstrate that the FL receives its own vascular supply from perforators of the DB originating from the LCFA. Hence, harvest of a fascia lata free flap is possible, reliable, and the size of the fascia is suitable for reconstruction of small and large defects of the head and neck.

摘要

目的

阔筋膜(FL)常被用作头颈部重建中股前外侧皮瓣(ALT)的筋膜成分。目前尚无明确的数据表明 FL 是否具有其自身可靠的血管供应,以及筋膜是否可以单独作为阔筋膜游离皮瓣进行采集。

方法

我们解剖了 15 具尸体的 25 条大腿。识别了旋股外侧动脉(LCFA)的外侧支,在向降支(DB)内注射亚甲蓝后,测量了染色筋膜和皮肤的大小。最后,确定了筋膜血管的分布情况。

结果

在所有 25 例中均发现筋膜和皮瓣染色。LCFA 的 DB 的升支发出的皮支为 FL 的供应提供了支持,从而可以采集阔筋膜游离皮瓣。隔肌或肌皮穿支穿过 FL 并在大腿近端的 38.6%-60%范围内进入皮肤。染色 FL 的平均长度和宽度分别为 15.8±4.1cm 和 8.7±2.0cm,染色 FL 的大小范围为 40.0-336.0cm。在 20 例(80%)中,皮瓣的平均面积比相应的 FL 大 2.4 倍。

结论

我们可以证明 FL 从 LCFA 的 DB 起源的穿支获得自身的血管供应。因此,采集阔筋膜游离皮瓣是可行的、可靠的,并且筋膜的大小适合头颈部小和大面积缺损的重建。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0d9/7198631/730e389b78af/405_2020_5861_Fig1_HTML.jpg

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