股深动脉第三穿动脉游离皮瓣的应用解剖学研究

发布时间：2018-01-05 11:01

本文关键词：股深动脉第三穿动脉游离皮瓣的应用解剖学研究　出处：《吉林大学》2011年硕士论文　论文类型：学位论文

【摘要】：四肢软组织缺损作为手外科及整形外科的常见病及疑难病,如今受到越来越多的重视,临床上通常选择植皮或者皮瓣移植术进行修复。相对于植皮术来讲,皮瓣移植术以其质地好,有恒定的血供,不仅可覆盖肌腱、骨骼外露的皮肤缺损,并且外形和功能满意,因此常作为修复四肢软组织缺损的首选术式。股后区一直被认为是开发新型游离皮瓣的良好供区。此处皮动脉大多数来自股深动脉分支,包括旋股内、外侧动脉及穿动脉；另外胭动脉及膝上内、外侧动脉也部分参与股后皮肤的血供,各动脉穿支进入皮下组织后,相互交汇呈网状结构,保证了软组织的充分血供,且该处血管较为恒定,管径较粗,供血范围大,有伴行静脉,因此以该处作为供区设计游离皮瓣具有可行性。本文通过对10侧成人下肢标本的解剖学研究,对股深动脉第三穿动脉的起止、走行、分支、外径、伴行静脉、供血范围、体表定位等进行系统观测及分析,以此支做血管蒂设计游离皮瓣,为四肢软组织缺损的修复提供一种新的修复方法。研究表明,股深动脉第三穿动脉发自股深动脉,起点距股骨内外髁连线中点以近117.65+4.66mm,起点外径1.658±0.15mm,发出后沿半膜、半腱肌与股二头肌肌间隙向股后外侧走行,于半膜、半腱肌和股二头肌之间分支形成升支及降支,升支起点外径0.73±0.06mm,穿出深筋膜后形成皮支,皮支起点距股骨内外髁连线中点以近110.39±4.82mm,外径为0.73+0.06mm。降支起点外径为0.826±0.05mm,向远端自然延伸。股深动脉第三穿动脉皮支有两条伴行静脉,两静脉于皮支近端汇合到股深动脉第三穿动脉伴行静脉,其外径为1.12+0.22mm。根据实验测得数据,可设计以股深动脉第三穿动脉为血管蒂,股后区皮肤为供区的游离皮瓣：该皮瓣以股骨内外髁中点连线以近110.00 mm处为轴心点,股后中线为轴心线,切取范围为26cm×9cm。本研究设计的皮瓣为四肢软组织缺损提供了一种新的修复方法,具有血管蒂恒定,外径粗,供皮面积大等优点,具有一定的临床应用及推广价值。
[Abstract]:The soft tissue defects of limbs as hand surgery and plastic surgery of the common diseases and difficult diseases, now has received more and more attention in clinical, usually choose skin graft or flap transplantation for repair. Compared with skin grafting, skin flap transplantation with its good texture, there is a constant blood supply, can not only cover the tendon, bone exposed skin the defect, and satisfactory appearance and good function, so often as the preferred method for repairing soft tissue defects of the extremities.
The posterior thigh has been considered to be good for the development of new district. The cutaneous artery flap from the branches of the deep femoral artery, including femoral circumflex artery and perforating artery, the lateral popliteal artery in the knee; in addition, the blood supply of skin lateral artery also take part in the stock after the perforating artery into the subcutaneous tissue after each other the intersection forms network structure, to ensure adequate blood supply of soft tissue, and the blood vessel is constant, larger diameter, blood flow range, with accompanying vein, so as for the design of free flap is feasible.
This paper through anatomical study on 10 adult lower limb specimens of deep femoral artery perforating artery, third of the starting and ending, walking, branch diameter, concomitant vein, blood supply range, observation and analysis system for surface positioning, in order to do vascular pedicle flap design, provide a new method for the repair of repair the soft tissue defect of extremities.
The research shows that the deep femoral artery third perforating artery from the deep femoral artery, the femoral condyle from the starting point at the midpoint of the starting point 117.65+4.66mm, diameter 1.658 + 0.15mm, issued along the semi membrane, semitendinosus and biceps muscle gap to the shares of two shares after the lateral walking, half film formed between the semitendinosus and branches unit two biceps ramus and descending ramus starting point diameter 0.73 + 0.06mm, through deep fascia formed after cutaneous branches and cutaneous branches of the femoral condyle from the starting point at the midpoint of the 110.39 + 4.82mm, diameter 0.73+0.06mm. descending starting point diameter was 0.826 + 0.05mm, distal to the natural extension of the deep femoral artery. Third perforating artery skin a two accompanying veins, vein in two cutaneous branches of the proximal to the confluence of the deep femoral artery third perforating artery accompanying vein, the outer diameter is 1.12+0.22mm.
According to the measured data, can be designed to the deep femoral artery third perforating artery as the pedicle skin flap for posterior femoral free: the flap in the femoral condylar midpoint was nearly 110 mm as the axis, the axis line shares, cut the scope of 26cm * 9cm. the research design flap for soft tissue defect provides a new repairing method has constant vascular pedicle diameter, thick, for the advantages of large area skin, has certain clinical application and popularization value.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322

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