腓肠内侧动脉穿支皮瓣的应用解剖与临床研究

发布时间：2018-04-24 23:21

本文选题：应用解剖 + 穿支皮瓣　；参考：《南华大学》2010年硕士论文

【摘要】： 第一章腓肠内侧动脉穿支皮瓣的应用解剖研究目的了解腓肠内侧动脉发出肌皮穿支的数目、区域、类型、外径,为腓肠内侧动脉穿支皮瓣的临床应用提供解剖学依据。方法选取6侧新鲜中国成人下肢标本进行显微解剖研究,系统观测腓肠内侧动脉的穿支数量、外径、蒂长、起始部外径、穿出点距乆皱褶及小腿后正中线的垂直距离,测量数据采用SPSS11.0统计软件分析处理。结果6侧下肢标本共观测到腓肠内侧动脉肌皮穿支13支,每侧1～3支,平均2.2支,其中由腓肠内侧动脉前支发出的有4支(31%),由后支发出的有9支(69%)。穿支穿出点位于距乆皱褶以远6.5～16.0cm、距后正中线1～4.5 cm,第一穿支距乆皱褶垂直距离平均为8.82±1.21 cm,距后正中线2.23±0.64 cm。起始部外径平均为外径2.52±0.35mm,穿支穿深筋膜处的外径平均为0.81±0.1mm。结论腓肠内侧动脉穿支恒定,携带源动脉能获得较长的血管蒂,有理想的血管吻合口径,具备游离移植及带蒂转移所要求的解剖学特点。第二章腓肠内侧动脉穿支皮瓣的临床研究目的探讨腓肠内侧动脉穿支皮瓣修复四肢皮肤软组织缺损的可行性,并分析其临床疗效。方法选择2008年6月至2009年10月收治的四肢中小面积皮肤软组织缺损患者10例,采用腓肠内侧动脉穿支皮瓣移植修复。其中游离移植修复8例,皮瓣面积5cm×4cm～16cm×8cm;带蒂转移修复2例,皮瓣面积7cm×5cm～10cm×6cm。术后3个月、6个月、9个月、12个月随访,观测皮瓣外形、血运、稳定性、感觉恢复情况、供区的外观及运动功能。结果本组10例皮瓣,9例顺利成活,1例皮瓣下积血出现静脉危象,经清除积血引流处理后危象解除,皮瓣成活。皮瓣受区和供区创面均一期愈合。术后随访3～12个月(平均8个月),1例稍臃肿,9例不臃肿,皮瓣色泽正常,质地柔软,无一例发生溃疡,感觉恢复到S2。7例皮瓣供区遗留线性疤痕,3例遗留植皮疤痕,肢体活动无影响。结论腓肠内侧动脉穿支皮瓣薄而柔软,皮瓣受区外形较美观,供区创伤小,游离移植适合修复四肢中小面积皮肤软组织缺损,带蒂转移适用修复膝部和小腿上段中小面积皮肤软组织缺损。
[Abstract]:The applied anatomical study of perforating branch flap of medial sural artery Objective to investigate the number, region, type and external diameter of cutaneous perforators from medial sural artery, and to provide anatomic basis for clinical application of perforating branch flap of medial sural artery. Methods six fresh Chinese adult lower limb specimens were selected for microanatomical study. The number of perforating branches, external diameter, pedicle length, external diameter of the medial sural artery, the external diameter of the initial part, the distance between the puncture points and the fold and the vertical distance of the median line after the calf were observed systematically. The measurement data were analyzed and processed by SPSS11.0 statistical software. Results A total of 13 musculocutaneous perforators of medial sural artery were observed in 6 lower extremities, with an average of 2.2 branches per side. Four of them were from the anterior branch of the medial sural artery and 9 from the posterior branch. The perforating point was located at the distance of 6.5 ~ 16.0 cm from the pleated body, 1 ~ 4.5 cm from the posterior median line, and 8.82 卤1.21 cm from the first perforating branch, and 2.23 卤0.64 cm from the posterior median line, and the average vertical distance from the first perforating branch was 8.82 卤1.21 cm, and from the posterior median line to 2.23 卤0.64 cm. The average external diameter of the initial part was 2.52 卤0.35 mm, and that of the perforating branch through the deep fascia was 0.81 卤0.1 mm. Conclusion the perforating branch of medial sural artery is constant, carrying the source artery can obtain a long vascular pedicle, it has ideal caliber of vascular anastomosis, and it has the anatomical characteristics required for free transplantation and pedicle transfer. The clinical study of perforating branch flap of medial sural artery Objective to investigate the feasibility and clinical effect of medial sural artery perforator flap in repairing skin and soft tissue defect of extremities. Methods from June 2008 to October 2009, 10 patients with small and medium area skin and soft tissue defects of extremities were treated and repaired with medial sural artery perforator flap. Free graft was performed in 8 cases, flap area was 5cm 脳 4cm~16cm 脳 8 cm, pedicle transfer was performed in 2 cases, and flap area was 7cm 脳 5cm~10cm 脳 6 cm. After 3 months, 6 months, 9 months and 12 months of follow-up, the shape, blood supply, stability, sensory recovery, appearance and motor function of the donor area were observed. Results among the 10 cases, 9 cases survived successfully and 1 case had venous crisis under the flap. The crisis was relieved after removing and drainage, and the flap survived. The wounds of the recipient and donor areas of the flap were healed at the first stage. Follow-up for 3 to 12 months (mean 8 months) showed that 9 cases were not bloated, the skin flap was normal in color, soft in texture, no ulcers occurred, and the sensation recovered to the linear scar of the flap donor area in 3 cases, and the skin graft scar was left in 3 cases. Physical activity has no effect. Conclusion the flap of perforating branch of medial sural artery is thin and soft, the shape of the recipient area of the flap is beautiful, the injury of donor area is small, the free transplantation is suitable for repairing the soft tissue defect of middle and small area skin of limbs. Pedicle transfer can be used to repair soft tissue defect of small and medium area of knee and upper lower leg.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322;R654.4

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