FREE RECTUS FEMORIS MUSCLE TRANSFER FOR ONE-STAGE RECONSTRUCTION OF ESTABLISHED FACIAL PARALYSIS
FREE RECTUS FEMORIS MUSCLE TRANSFER FOR ONE-STAGE RECONSTRUCTION OF ESTABLISHED FACIAL PARALYSIS
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DOI：
10.1097/00006534-199409000-00001
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发表时间：
1994-09-01
影响因子：
3.6
通讯作者：
OHTA, S
中科院分区：
文献类型：
--
作者：
KOSHIMA, I;MORIGUCHI, T;OHTA, S
采用带长运动神经的股直肌游离移植一期修复单侧面瘫。将带蒂血管与同侧面受体血管吻合，肌肉运动神经穿过上唇，与对侧面神经缝合。与涉及第二阶段重建的手术相比，这种一期重建的优点是重建可以在一个阶段完成，而且手术后肌肉恢复功能所需的时间很短。股直肌的血供主要来自旋股动脉的后方。在我们的身体研究中，发现了肌肉滋养动脉起源的五种类型的变异。最常见的类型是起源于旋股外侧动脉降支的动脉(39%)。股直肌运动神经来源于腹股沟韧带下的股神经，向下穿过缝匠肌和髂腰肌之间的肌肉间隙，进入直肌上1/3的后内侧部。使用直肌的优点是：(1)安全、简单，只有一个主要的大动脉供血供动脉吻合；(2)股神经的长度(大于20 cm)足以到达对侧的面神经进行缝合；(3)患者在仰卧位时可以同时进行两组手术；(4)收缩的力量和距离适合于面部的恢复；(5)可以将直肌分离成长度合适的一段；(6)两端的腱筋膜提供了可靠的锚定缝合点，提供了更牢固的附着物；(7)供体小腿功能没有损失。
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 sugery is short. The vascular supply of the rectus femoris muscle can emanate mainly from the later 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 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 thant 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; (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.