Transverse Internal Pudendal (TIP) Flap in Vulvo-Vaginal Reconstruction

橫向內陰皮瓣作為陰部陰唇之重建

Jin K. Chun ； Harvey J. Bluestein ； Amir Babak Behnam ； Peter Dottino ； Lester Silver

《中華民國重建整形外科醫學會雜誌》 7卷1期 (1998/03) Pp. 1-7

https://doi.org/10.7096/JPRSA.199803.0003

摘要

女性陰道及陰唇之癌症作根除手術後之重建往往是相當困難的。過去有人報告用薄肌皮瓣(Gracillis myocutaneous flap)及其類似的皮瓣而有成功的例子。然而這些皮瓣可能太厚，而同時其血循也不是很可靠，留下來的疤痕也是其不太受贊同之處。肌膜皮瓣如Wee及Joseph所創造的陰大腿皮瓣則明顯的也有問題，因為它們的皮瓣尖端伸入躐蹊部所以很靠近腫瘤部位。因此我們才想到要用不同的皮瓣來替代。
利用內陰動脈(Internal pudendal artery)作為血源基礎來發現新的皮瓣。這篇文章的目的是做解剖學上的探討一個橫向的肌膜皮瓣並基於內陰神經動脈莖的血源上，用來作為陰唇及陰道之腫瘤切除後之重建上。
在保存好的屍體上分離內陰動脈可發現它供血給臀部皺折處。在新鮮屍體上用亞克力膠(Acrylic latex)注射進血管中研究內陰動脈之血液供應範圍，並證明橫向內陰皮瓣為單一血管莖所支配。
我們經驗過四個病人以此內陰神經動脈皮瓣來重建陰部腫瘤切除後之傷口得到外觀及機能上均佳的結果。此新的皮瓣似乎也可應用在其他會陰周圍之先天性、後天性及慢性病灶的重建工作上。

並列摘要

Vulvar and vaginal reconstruction after radical extirpative resections remains a complex surgical problem. The gracilis musculocutaneous flap and its variants have been previously used with variable success. However, these flaps may be too bulky, are not always reliable, and the resultant scars can be objectionable. The fasciocutaneous flaps such as the pudendal thigh flaps by Wee and Joseph may obviate some of the problems but the tips of these flaps may extend into the inguinal region which may be involved with the tumor. We therefore sought out alternative sources of donor flap tissue. The internal pudendal artery as a source vessel was investigated for a new flap design. The purpose of this paper is to report our anatomic investigation of a transversely oriented fasciocutaneous flap which is based on an internal pudendal neurovascular pedicle, and to discuss our clinical experience with vulvar and vaginal reconstruction using this flap following oncological resection procedures.
Preserved cadavers were dissected to confirm the clinically observed internal pudendal neurovascular bundle which appeared to supply the gluteal fold region, Next, fresh cadavers were used for acrylic-latex injection studies of the cutaneous territory supplied by the internal pudendal vessels. The transverse internal pudendal (TIP) flap was demonstrated to be based on a single neurovascular pedicle. Four patients were reconstructed using the bilateral transverse internal pudendal (TIP) flaps. Details of the procedure are given. We demonstrated that bilateral TIP flaps can be utilized safely in immediate gynecological oncologic reconstructions to provide a sensate and potentially functional vagina with cosmetically acceptable donor site scars. This new fasciocutaneous flap offers advantages over other musculocutaneous and fasciocutaneous flaps and may have applications to other areas of perineal reconstruction, including congenital and acquired deformities and chronic perineal wounds.

並列關鍵字

vaginal reconstruction ； fasciocutaneous flap ； internal pudendal vessels