Ramirez O M, Hurwitz D J, Futrell J W
Plast Reconstr Surg. 1984 Dec;74(6):757-70. doi: 10.1097/00006534-198412000-00003.
The rich vascular network of the gluteal and posterior thigh region provides for a larger range of flaps for reconstructive surgery than previously described. Facility with these flaps requires an appreciation of relevant anatomy, embryology, and anthropology. Structural changes in the gluteus maximus muscle are critical to the evolutionary advance toward an upright stance during walking. The superficial and deep segmentation of the gluteus maximus are best appreciated by phylogenic and ontogenetic study. Femoral arterial and gluteal arterial anastomotic hemodynamics are affected by the relative involution of the gluteal system in late embryogenesis. The gluteal thigh flap should include contributions from the femoral system when the cutaneous branch of the inferior gluteal artery cannot be identified. Huge sacral wounds can be closed with gluteus maximus myocutaneous flaps with maintenance of muscular function by detaching the entire origin, sliding the muscle medially, and reconstructing these attachments. By dissection between the divergent inserting fibers of the gluteus maximus, a long, superficial portion of the muscle can be raised that forms the basis of the extended gluteus maximus flap. The pedicle of the flap is at the level of the piriformis muscle and the skin paddle can be placed over the midportion of the posterior thigh. Finally, the first deep femoral perforating artery forms the basis of a posterolateral fasciae latae flap that is well suited for coverage of defects over the trochanter.
臀区和大腿后部丰富的血管网络为重建手术提供了比以往描述更多的皮瓣选择。熟练运用这些皮瓣需要了解相关的解剖学、胚胎学和人类学知识。臀大肌的结构变化对于行走时向直立姿势的进化进程至关重要。通过系统发生学和个体发生学研究，能更好地理解臀大肌的浅部和深部划分。在胚胎发育后期，臀部系统的相对退化会影响股动脉和臀动脉的吻合血流动力学。当无法识别臀下动脉的皮支时，臀大腿皮瓣应包含来自股部系统的成分。巨大的骶部伤口可用臀大肌肌皮瓣闭合，通过分离整个起点、将肌肉向内侧滑动并重建这些附着点来维持肌肉功能。通过在臀大肌分散插入的纤维之间进行解剖，可以掀起一块长的浅部肌肉，形成延长臀大肌皮瓣的基础。皮瓣的蒂位于梨状肌水平，皮瓣可置于大腿后部的中部。最后，第一股深穿动脉构成了股外侧筋膜皮瓣的基础，该皮瓣非常适合覆盖转子区的缺损。
