Objective: To investigate the anatomical basis for the preparation of the profunda artery perforator flap (PAPF) in the posteromedial femoral region and its application in the reconstruction of oral and maxillofacial defects. Methods: Six lower limbs of Chinese adult cadavers were micro-surgically dissected. CT angiography (CTA) data of bilateral lower limbs of 6 patients was also collected retrospectively. The number, external diameter, pedicle length, and distribution of perforators in the posteromedial femoral region were recorded from the specimens and CTA data. Meanwhile, 10 patients with oral squamous cell carcinoma in the Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University from August 2018 to June 2021 were treated with the PAPF. At each follow-up, contour and function of recipient and donor site, as well as swallowing and speech function were evaluated. Results: A total of 19 profunda artery perforator were identified in 6 lower limb specimens. The outer diameter at the beginning of the source artery was (2.34±0.25) mm and the total length of the pedicle was (11.12±1.06) cm. CTA data analysis of 12 legs identified 15 perforators of profunda artery in the posteromedial region. Eleven perforators were septocutaneous, including 2 perforators with a common trunk, while the remaining 4 perforators were musculocutaneous. As for different patterns of perforators (septocutaneous perforators, musculocutaneous perforators and perforators with a common trunk), the longitudinal distance to the pubic tubercle was (19.95±2.43), (21.84±2.54) and (19.48±0.55) cm respectively. The horizontal distance to the posterior edge of gracilis was (3.54±1.10), (3.72±0.30) and (3.85±1.48) cm, respectively. The initial diameters of perforators was (2.4±0.4), (2.6±0.6) and 1.9 mm respectively. Ten cases of the profunda artery perforator flaps survived successfully after operation. The flap sizes ranged from 8 cm×6 cm to 12 cm×7 cm. The patients were evaluated at 1, 3 and 6 months, and with 6 months interval ever since. During the follow-up, the shape of the recipient site was ideal, and the swallowing and language functions were not significantly affected. There was only linear scar in the donor area, and the function of the thigh was basically normal. Conclusions: PAPF possessed a good anatomic stability, suitable vascular pedicle length and diameter, minor influence to the donor area, sufficient amount tissue with good quality. It is an ideal choice for head and neck reconstruction.
目的： 探讨制备股后内侧区股深动脉穿支皮瓣（profunda artery perforator flap，PAPF）的解剖学基础及其在口腔颌面部缺损修复重建中的应用。 方法： 选取6例中国成人下肢标本以氧化铅混合红色乳胶灌注后解剖观测股后内侧区，结合6例12侧腿部CT血管造影（CT angiography，CTA）数据，分析股深动脉穿支在部分层面的血管外径、长度、走行方式及分布特征。同时采用股后内侧PAPF对2018年8月至2021年6月在南京医科大学附属口腔医院口腔颌面外科就诊的10例口腔鳞状细胞癌患者进行缺损修复重建，观察患者受区外形、术后吞咽及语言功能、供区外观和功能恢复情况。 结果： 6例下肢标本共解剖发现股后内侧股深动脉穿支19条。源动脉起始处外径为（2.34±0.25）mm，血管蒂总长度为（11.12±1.06）cm。6例腿部CTA数据分析发现，12侧股后内侧区域共发现15个股深动脉来源穿支，其中肌间隔穿支11个，肌皮穿支4个。肌间隔穿支、肌皮穿支和共干穿支沿X轴与耻骨结节距离分别为（19.95±2.43）、（21.84±2.54）和（19.48±0.55）cm；沿Y轴与股薄肌后缘距离分别为（3.54±1.10）、（3.72±0.30）和（3.85±1.48）cm；穿支起始管径分别为（2.4±0.4）、（2.6±0.6）和1.9 mm。临床取用10例股深动脉穿支皮瓣术后均顺利存活。皮瓣面积为（8 cm×6 cm）~（12 cm×7 cm）。术后随访9~36个月，患者受区外形理想，吞咽、语言功能均无明显影响；供区仅遗留线状瘢痕，大腿活动功能基本正常。 结论： 股后内侧PAPF穿支数目及分布稳定，血管蒂长度及管径满足修复要求，供区影响小，组织量充分，可作为口腔颌面部软组织缺损修复重建的理想选择。.