摘要目的 为联合应用背阔肌两块节段肌瓣一期动力矫正晚期面瘫表情肌功能提供解剖学依据.方法 解剖20具10%福尔马林固定的成人尸体共40侧背阔肌标本,醋酸乙酯血管灌注2具新鲜成人尸体共3侧背阔肌标本,观察肌外、肌内神经血管的分布特点.结果 ①92.5%的胸背神经分为内、外侧支;7.5%的胸背神经分为内、中、外侧支.胸背神经内、外侧支分叉点的坐标为(7.94±1.23)em、(3.71±1.68)cm,在该交角的中线区域,神经血管的数量相对较少.②背阔肌外侧肌瓣可以分为3～5个亚单位,内侧肌瓣可以分为2～4个亚单位.③肌内神经血管分支排列关系(由内向外),内侧节段100%为NVAV(神经、静脉、动脉、静脉),外侧节段85.0%为VAVN,其余15.0%为NVAV.④在神经蒂分支点外侧切断,第三段内侧肌瓣神经蒂平均达16 cm,第三或四段外侧肌瓣神经蒂平均达12 cm.结论 吻合血管神经的背阔肌双节段肌瓣移植可一期跨面修复晚期面瘫.

abstractsObjective To provide anatomical basis for one-stage full dynamic correction of late facial palsy with double latissimus dorsi segmental muscle flaps.Methods Forty sides of formaldehyde fixed latissimus dorsi in twenty cadavers were selected to microsurgery anatomy,three sides fresh latissimus dorsi specimens were blood vessel casted.The extramusclar and intramuscular neurovascular distribution were observed.Results ①In 92.5%of the thoracodorsal nerve divides into a medial and a lateral branch before entering the muscle.In 7.5%of the thoracodorsal nerve divides into three major branches.The coordinate of the bifurcation point of the thoracodorsal Here was[(7.94±1.23)cm,(3.71±1.68)cm].In the district of this angle's middle line,the numbers of vessels and nerves is relative few.②The lateral muscle flaps of the latissimus dorsi can be divided into 3-5 independent segmental flaps,the medial muscle flaps of the latissimus dorsi Can be divided into 2-4 independent segmental flaps.③The segmental nerve usually locate the two sides of vessel,which are arranged(from medial to lateral)in a NVAV order in the reedial segmental branches(100%),in a VAVN order in the lateral segmental branches(85.0%)and in a NVAV order in the lateral segmental branches(15.0%).④The neural pedicle Was cut from the lateral bifurcation point,the mean length of the third medial muscle neural pedicle was 16 cm；the mean length of the third or the forth lateral muscle neural pedicle was 12 cm.Conclusion Late facial palsy can be cuwd with onestage cross-facial transplantation of neurovascularized free double latissimus dorsi segmental muscle flaps.