颏下皮瓣解剖学及临床应用的研究

发布时间：2018-04-15 06:20

本文选题：颏下血管 + 颏下皮瓣　；参考：《中国协和医科大学》2007年硕士论文

【摘要】： 颏下皮瓣解剖学及临床应用的研究颏下皮瓣用于临床已有10多年的历史，，它位于颏下区，有可靠的动脉供应及静脉回流，该皮瓣可以以多种形式应用于临床。皮瓣成活率达93.09％，常见的并发症为皮瓣坏死和下颌缘神经损伤。但目前国内尚缺乏详尽的应用解剖学研究，并且在临床应用时，有并发症发生，因此有必要进行更详细的解剖学研究以指导临床实践。【目的】 (1)颏下区皮肤组织学特点决定了颏下皮瓣是修复面部及口腔缺损的可用的皮瓣之一。本研究通过对成人尸体的解剖学研究，为颏下皮瓣的临床应用提供更加详尽的形态学和解剖学依据，从而达到减少临床应用时并发症的发生的目的。(2)通过将上述解剖结果应用于临床，观测临床应用颏下皮瓣时的血运及成活情况，评价该皮瓣的安全可靠程度及临床应用前景。【方法】 (1)将14例甲醛固定的成人尸体标本，行红色或黑色乳胶灌注处理，制成透明标本和灌注标本；重点观察并测量颏下血管的起始、走行、分支、体表投影及吻合支的情况，以及其与周围神经血管的相互关系；对测量数据进行描述性统计分析；并对尸体左右两侧的重点指标进行t检验。(2)通过临床病例观察，总结颏下皮瓣的临床应用经验。【结果】 (1)颏下皮瓣由颏下血管供血，颏下动脉是面动脉的恒定分支。面动脉在距下颌骨下缘7.23±2.65 mm、下颌角前19.34±5.06 mm和在距其起点27.16±1.21 mm处时发出的颏下动脉，颏下动脉的出现率100％。颏下动脉起点处的直径为1.86±0.96 mm，颏下静脉的直径为1.97±0.73 mm。经过t检验，表明左右两侧数据没有显著性差异。(2)颏下皮瓣血运可靠，静脉回流充分，可顺行或逆行转位，或经皮肤软组织扩张器扩张后，用于修复面部、口腔的缺损。手术后皮瓣存活良好，皮瓣的颜色、质地良好，供区瘢痕隐蔽，患者满意。【结论】 (1)颏下动脉是支配颏下区的恒定而可靠的动脉，颏下动脉起点及走行相对较固定；颏下静脉位置恒定，与颏下动脉伴行；鉴于颏下区有可靠的动脉血液供应及静脉回流，故可设计出多种形式的皮瓣。(2)该皮瓣具有蒂长恒定、血供可靠、切取方便、带有感觉神经、不牺牲主干血管及供区隐蔽、可一期直接缝合等优点。(3)该皮瓣可跨越中线制备成逆行轴型皮瓣，亦可通过埋置皮肤软组织扩张器预制成扩张后皮瓣，修复面部及口腔缺损。因此临床上可作为修复面部及口腔缺损的常规皮瓣。
[Abstract]:Study on anatomy and clinical application of submental flapThe submental flap has been used in clinic for more than 10 years. It is located in the submental region and has reliable arterial supply and venous reflux. The flap can be used in clinical practice in many forms.The survival rate of flap was 93.099.The common complications were flap necrosis and mandibular nerve injury.However, there are few detailed applied anatomy studies in China, and there are complications in clinical application, so it is necessary to conduct more detailed anatomical research to guide clinical practice.[purpose]1) the submental skin flap is one of the useful flaps for repairing facial and oral defects.This study provides more detailed morphological and anatomical basis for clinical application of submental flap through anatomical study of adult cadavers.By applying the above anatomical results to clinic, the blood circulation and survival of the submental flap were observed, and the safety and reliability of the flap and the prospect of clinical application were evaluated.[methods]14 formaldehyde-fixed adult cadavers were perfused with red or black latex to make transparent specimens and perfused specimens. The origin, movement, branch, projection of body surface and anastomotic branches of submental vessels were observed and measured.And its relationship with peripheral nerve and blood vessels; the descriptive statistical analysis of the measured data; and the t test on the left and right sides of the cadaver.) the clinical application experience of the submental flap was summarized through clinical case observation.[results]1) the submental flap is supplied by submental vessels, and the submental artery is a constant branch of the facial artery.The occurrence rate of the inferior mental artery was 100% when the facial artery was 7.23 卤2.65 mm from the lower margin of the mandible, 19.34 卤5.06 mm before the mandibular angle and 27.16 卤1.21 mm from its starting point.The diameter of the submental artery and the submental vein were 1.86 卤0.96 mm and 1.97 卤0.73 mm respectively.T test showed that there was no significant difference between the left and right sides. 2) the submental flap had reliable blood flow, sufficient venous reflux, and could be used to repair the defects of the face and mouth after the expansion of the skin and soft tissue expander or the anterograde or retrograde transposition.After operation, the flap survived well, the color and texture of the flap were good, the donor scar was concealed, and the patient was satisfied.[conclusion]1) the submental artery is a constant and reliable artery that innervates the submental area, and the starting point and course of the submental artery are relatively fixed; the position of the submental vein is constant and accompanied by the submental artery; and since there is a reliable arterial blood supply and venous reflux in the submental region,The flap has the advantages of constant pedicle length, reliable blood supply, convenient removal, sensory nerve, no sacrificing of the main blood vessels and concealment of the donor area.The flap can be made into a retrograde axial flap across the midline or prefabricated into an expanded skin flap by embedding a soft tissue expander to repair the defects of the face and mouth.Therefore, it can be used as a routine flap to repair facial and oral defects.
【学位授予单位】：中国协和医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R622;R322

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