Chan Stephanie Li-Shan, Wong Manzhi, Tan Bien-Keem
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
J Plast Reconstr Surg. 2022 Apr 9;1(2):44-51. doi: 10.53045/jprs.2021-0024. eCollection 2022 Jul 27.
Motor neurotization is essential for functional muscle transfer. The aims of this anatomical study were to map the course of the vastus lateralis muscle motor nerve and determine the axonal counts of the main trunk and its branches to assess its suitability as a free functional muscle transfer.
Ten cadaveric thighs were dissected. The length of the nerve and its branches were measured, harvested en bloc, and cross-sectioned at its origin and each branch. Their calibers and axonal counts were analyzed. The vastus lateralis muscle was used for a functional muscle transfer in a clinical case of upper lip reconstruction.
The branches of the vastus lateralis muscle motor nerve coursed adjacent to the branches of the lateral circumflex femoral artery. Two nerve branching patterns were identified. Type 1 (70%) consisted of two branches, the transverse and descending. Type 2 (30%) consisted of three branches, the transverse, oblique, and descending. The average lengths and axonal counts of the transverse, oblique, and descending branches were 7.1, 6.7, and 15.2 cm and 1021, 545, and 1158, respectively. The average lengths of the accompanying transverse, oblique, and descending branches of the lateral circumflex femoral artery were 5.7, 9.0, and 10.3 cm, respectively. Our clinical case regained muscle function and oral sphincter competency.
Three types of muscle segments of the vastus lateralis muscle may be harvested for functional muscle transfer based on the descending (type A), oblique (type B), and transverse (type C) nerve branches. Types A and C have axonal counts matching the buccal branches of the facial nerve. Clinically, type A functional muscle transfer for lip reconstruction was validated.
运动神经化对于功能性肌肉移植至关重要。本解剖学研究的目的是描绘股外侧肌运动神经的走行，并确定其主干及其分支的轴突数量，以评估其作为游离功能性肌肉移植的适用性。
解剖10具尸体大腿。测量神经及其分支的长度，整体取下并在其起点和每个分支处进行横切。分析它们的管径和轴突数量。在一例上唇重建的临床病例中使用股外侧肌进行功能性肌肉移植。
股外侧肌运动神经的分支与旋股外侧动脉的分支相邻走行。确定了两种神经分支模式。1型（70%）由两支组成，即横行支和下行支。2型（30%）由三支组成，即横行支、斜行支和下行支。横行支、斜行支和下行支的平均长度和轴突数量分别为7.1 cm、6.7 cm、15.2 cm和1021、545、1158。旋股外侧动脉的伴行横行支、斜行支和下行支的平均长度分别为5.7 cm、9.0 cm和10.3 cm。我们的临床病例恢复了肌肉功能和口轮匝肌功能。
基于下行（A型）、斜行（B型）和横行（C型）神经分支，股外侧肌的三种类型的肌肉段可用于功能性肌肉移植。A型和C型的轴突数量与面神经颊支相匹配。临床上，已验证A型功能性肌肉移植用于唇部重建。
