带下部前锯肌的侧胸皮瓣解剖研究和临床应用

发布时间：2018-05-31 14:11

本文选题：下部前锯肌 + 侧胸皮瓣　；参考：《安徽医科大学》2011年硕士论文

【摘要】：目的:研究前锯肌尤其是其下部肌肉的血供、神经及其侧胸皮瓣的解剖学特点,介绍以胸背动脉前锯肌支为蒂的侧胸皮瓣的临床应用。方法:解剖观测8具(16侧)尸体标本的前锯肌形态、胸背动脉、胸长神经、前锯肌支的走行、分支和分布特征。观测前锯肌支和肋间动脉穿支对侧胸壁皮肤的血供,及其两者在下部前锯肌肉内吻合情况。其中在1例新鲜尸体上,注入蓝色墨汁,观测侧胸壁皮肤染色范围。在解剖研究的基础上,应用以胸背动脉前锯肌支为蒂的带下部前锯肌的侧胸皮瓣游离或带蒂移植修复肢体皮肤软组织缺损7例。结果:下部前锯肌的血供主要来自胸背动脉的前锯肌支,平均直径为(1.7±0.4)mm,以前锯肌支为蒂的肌皮侧胸皮瓣蒂长为(4.2±1.1)cm。覆盖下部前锯肌的侧胸皮瓣血供主要来自肋间动脉穿支和前锯肌支皮支,两分支之间在下部前锯肌内存在着丰富的交通吻合。临床应用游离下部前锯肌侧胸皮瓣6例,带蒂转移修复胸前壁皮肤缺损创面1例,7例均成活。侧胸皮瓣切除面积最小4.5cm×8cm,最大10.5cm×15cm。随访6～10个月,皮瓣外形均满意,无需二次手术修薄皮瓣。供区隐蔽,无前锯肌功能障碍。结论:本研究为前锯肌下部侧胸皮瓣安全可靠地切取提供解剖依据。下部前锯肌侧胸皮瓣血管蒂长、解剖位置恒定、血运丰富,切取皮瓣面积较大。在修复肢体皮肤软组织缺损应用方面具有很好的前景。
[Abstract]:Objective: to study the blood supply, nerve and lateral thoracic flap anatomy of serratus anterior muscle, especially its lower muscle, and to introduce the clinical application of lateral thoracic flap pedicled with anterior serratus muscle branch of dorsal thoracic artery. Methods: the morphology of serratus anterior, the dorsal thoracic artery, the long thoracic nerve and the branches, branches and distribution of serratus anterior muscle in 8 cadavers (16 sides) were observed. The blood supply of the contralateral chest wall of the anterior serratus branch and intercostal artery perforating branch and their anastomosis in the lower anterior serrated muscle were observed. Blue ink was injected into one fresh corpse and the extent of skin staining on the lateral chest wall was observed. On the basis of anatomical study, 7 cases of soft tissue defects of extremities were repaired by free or pedicled lateral thoracic flap pedicled with inferior serratus anterior serratus branch of thoracic dorsal artery. Results: the blood supply of the inferior serratus came mainly from the anterior serratus branch of the dorsal thoracic artery, with an average diameter of 1.7 卤0.4 mm, and the pedicle length of the pedicle of the musculocutaneous skin flap pedicled with the anterior serratus branch was 4.2 卤1.1 cm. The blood supply of the lateral thoracic flap covering the lower anterior serratus mainly comes from the perforating branch of intercostal artery and the cutaneous branch of the anterior serratus branch, and there is abundant traffic anastomosis between the two branches in the inferior anterior serratus muscle. Clinical application of free lower serratus lateral thoracic flap in 6 cases, pedicle transfer repair of chest anterior wall skin defect in 1 case, 7 cases survived. The area of lateral thoracic flap was the smallest 4.5cm 脳 8 cm, and the maximum of 10.5cm 脳 15 cm. Follow up for 6 ~ 10 months showed that the skin flap was satisfactory in appearance and no need for secondary operation to repair the skin flap. The donor area was concealed and there was no dysfunction of serratus anterior muscle. Conclusion: this study provides anatomic basis for the safe and reliable excision of the lower serratus anterior thoracocutaneous flap. The proximal serratus anterior thoracic flap has long pedicle, constant anatomical position, abundant blood supply, and larger area of skin flap. It has a good prospect in repairing limb skin and soft tissue defect.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322.1

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