Koshima I, Moriguchi T, Soeda S, Hamanaka T, Tanaka H, Ohta S
Department of Plastic and Reconstructive Surgery, Kawasaki Medical School, Okayama, Japan.
Plast Reconstr Surg. 1994 Sep;94(3):421-30. doi: 10.1097/00006534-199409000-00001.
The free vascularized rectus femoris muscle graft with a long motor nerve was used for reconstruction of unilateral established facial paralysis in one stage. The pedicle vessels were anastomosed to the recipient vessels in the ipsilateral face, and the motor nerve of the muscle, which was led through the upper lip, was sutured to the contralateral facial nerve. The advantages of this one-stage reconstruction as compared with surgery involving second-stage reconstruction are that the reconstruction can be completed in one stage and that the period required for muscle refunctioning after surgery is short. The vascular supply of the rectus femoris muscle can emanate mainly from the lateral circumflex femoral artery. In our cadaveric study, five types of variation were found for origination of a nutrient artery of the muscle. The most common type was one in which the artery derived from the descending branch of the lateral circumflex femoral artery (39 percent). The motor nerve of the rectus femoris muscle is derived from the femoral nerve under the inguinal ligament and runs downward through the intermuscular space between the sartorius muscle and the iliopsoas muscle before entering the posteromedial part of the upper third of the rectus muscle. The advantages of using the rectus muscle are as follows: (1) safety and simplicity exist with one main large arterial supply for arterial anastomosis; (2) the length of the femoral nerve (more than 20 cm) is adequate for reaching the contralateral facial nerve for suturing; (3) a simultaneous operation by two teams is possible with the patient in the supine position; (4) the force and distance of contraction are appropriate to reanimate the face; (5) the rectus muscle can be separated as a segment with appropriate lengths, size, and power for replacing lost muscles in the face; (6) the tendinous fascia in both ends provides a reliable point for anchoring sutures, which provides firmer attachment; and (7) no loss of donor leg function occurs.
采用带长运动神经的游离血管化股直肌肌瓣一期修复单侧陈旧性面瘫。将蒂部血管与同侧面部的受区血管吻合，肌肉的运动神经经上唇引出后与对侧面神经缝合。与二期修复手术相比，一期修复的优点是可一次性完成修复，术后肌肉功能恢复所需时间短。股直肌的血供主要来自旋股外侧动脉。在我们的尸体研究中，发现该肌营养动脉的起始有5种变异类型。最常见的类型是动脉发自旋股外侧动脉降支（39%）。股直肌的运动神经来自腹股沟韧带下方的股神经，向下经缝匠肌与髂腰肌之间的肌间隙，然后进入股直肌上1/3后内侧部。使用股直肌的优点如下：（1）有单一主要大动脉供血用于动脉吻合，安全且操作简单；（2）股神经长度（超过20cm）足以到达对侧面神经进行缝合；（3）患者仰卧位时，两个手术团队可同时进行手术；（4）收缩力和收缩距离适合面部功能重建；（5）股直肌可按适当长度、大小和力量分离成段，用于替代面部缺失的肌肉；（6）两端的腱膜提供可靠的缝合固定点，固定更牢固；（7）供区下肢功能无损失。
