目的 通過對二腹肌后腹大體和顯微解剖，觀察二腹肌后腹的位置與毗鄰關系，為臨床治療提供依據。 方法 2011年2月－2012年6月，對10具20側成人尸體標本作解剖學研究，觀察二腹肌后腹與周圍相鄰組織結構的位置。 結果 二腹肌后腹位置恒定，其深面有重要的神經血管。依次有寰椎橫突、頸內靜脈、枕動脈、副神經、頸外動脈、面動脈、舌下神經及耳后動脈等重要結構。 結論 掌握二腹肌后腹的外科解剖特點，在進行頜面外科手術時，可以避免損傷有關神經和血管等重要結構，具有重要的臨床指導意義。
ObjectiveTo investigate the efficacy of anterolateral thigh (myocutaneous) flap designed with computed tomography angiography (CTA) to reconstruct oral and maxillofacial soft tissue defects.MethodsBetween January 2011 and December 2015, 23 cases of oral and maxillofacial tumors were treated. There were 14 males and 9 females with the age range from 45 to 72 years (mean, 56.8 years). There were 12 cases of tongue carcinoma, 5 cases of buccal mucosa carcinoma, 4 cases of mouth floor carcinoma, and 2 cases of oropharynx carcinoma; all were squamous cell carcinoma. According to standard TNM staging of the Union for International Cancer Control (UICC), 8 cases were rated as T2N0M0, 3 cases as T2N1M0, 1 case as T2N2M0, 4 cases as T3N0M0, 2 cases as T3N1M0, 2 cases as T3N2M0, 2 cases as T4N1M0, and 1 case as T4N2M0. The course of disease was 1-6 months (mean, 2.4 months). CTA was performed before operation to locate the perforator vessel and its surface projection of emerging point and to design anterolateral thigh (myocutaneous) flap by computer. The defects of soft tissue ranged from 6 cm×4 cm to 11 cm×7 cm after resection of tumor. The flap was used to repair defects, including 14 thinned anterolateral thigh flaps, 7 anterolateral thigh myocutaneous flaps, and 2 anterolateral bilobed flaps; and the flap area ranged from 7 cm× 5 cm to 12 cm×8 cm. The donor sites were sutured directly.ResultsCTA showed that myocutaneous perforators penetrated at the fascias of the vastus lateralis muscles in 22 cases with a location rate of 95.7% (22/23). Submandibular fistula occurred in 1 case at 5 days after operation and fistula healed after changed dressings. Other wounds at recipient site and donor site healed at primary stage. Anastomose with 2 vein was performed because of poor venous return in 1 case, and the flap survived. The other flaps survived well. All the patients were followed up 6-36 months (mean, 16.4 months). At 3 months after operation, the simplified recovery standard of speech function and swallow function was established according to the University of Washington Quality of Life Scale (UW-QOL). The speech and swallow function recovered satisfactorily in 22 cases, and not very satisfactorily in 1 case of well differentiated squamous cell carcinoma of the right mouth floor (T 4N1M0). No obvious tissue atrophy was observed in 23 cases. No dysfunction was found at the donor site. There was no tumor recurrence in 21 patients; 1 patient accepted the second operation due to lymphonodi metastasis of contralateral neck at 6 months after first operation, who died after 23 months; 1 patient died of distant metastasis at 10 months after first operation.ConclusionThe anterolateral thigh (myocutaneous) flap designed with CTA could well recover the morphology and function of the recipient site.