改良前额旁正中皮瓣鼻再造术的解剖学和临床应用研究

发布时间：2018-06-29 09:00

本文选题：鼻再造术 + 滑车上动脉　；参考：《南京医科大学》2008年硕士论文

【摘要】： 目的通过对滑车上动脉的解剖研究,观察该血管的走行特点明确其与皮肤和额肌的层次关系。据此设计少携带额肌的改良前额旁正中皮瓣,并行鼻再造术。方法对7具成人尸体前额部标本(12侧滑车上动脉)进行解剖,以眶上缘和前正中线为参考点分别记录滑车上动脉的发出点位置、管径、长度、走行过程中与额肌及皮肤的层次关系、分支情况以及与眶上动脉、颞浅动脉额支的吻合情况。根据解剖结果,在临床上设计仅蒂部带少量额肌的改良前额旁正中皮瓣行鼻再造术,术中观察滑车上动脉走行层次、皮瓣存活情况,术后随访再造鼻色泽、外形,鼻翼、鼻尖、鼻小柱等情况及患者对再造鼻的满意度。结果 12侧滑车上动脉均由滑车上切迹发出,发出点距前正中线(1.33±0.14)cm,发出点血管外径为(1.28±0.22)mm,主干与眶上缘水平成角约82度向内上方行走,全长(5.98±0.64)cm。以眶上缘水平和眶上缘水平上(0.93±0.23)cm为界限,自发出点至血管终点,其主干走行可分为三段:第一段自发出点至眶上缘水平,滑车上动脉行于眼轮匝肌与皱眉肌之间;第二段自眶上缘水平至眶上缘水平上(0.93±0.23)cm,滑车上动脉在距前正中线(1.21±0.15)cm的眶上缘水平,穿越额肌,紧贴额肌表面走行;第三段自眶上缘水平上(0.93±0.23)cm至终点,滑车上动脉浅行于浅层皮下,并逐渐浅出至皮内。5具尸体(8侧)滑车上动脉于眶上缘水平上(1.26±0.20)cm向外上发出分支行于皮下水平。两侧滑车上动脉之间及滑车上动脉与同侧眶上动脉、颞浅动脉额支有广泛交通吻合。额肌内没有发现明显轴形走行的滑车上动脉肌支血管。临床运用改良前额旁正中皮瓣行鼻再造术3例,术中发现前额皮下存在轴形走向的滑车上动脉属支,皮瓣色泽皮温正常无血运障碍,术后皮瓣全部存活2例,有1例出现皮瓣周边少量坏死,换药后自愈。术后随访6-9月皮瓣无挛缩,色泽正常,鼻背、鼻翼、鼻尖、鼻小柱形态厚度接近正常,鼻侧壁不臃肿,患者对手术效果满意。结论滑车上动脉自眶上缘水平穿出额肌,以主干形式走行于皮下组织与额肌层之间,渐行渐浅,沿途发出短小肌支和皮支分别营养额肌与前额皮肤。因而可以设计仅蒂部带少量额肌的前额旁正中皮瓣行鼻再造术以达到使再造鼻更符合美学标准,前额供区损伤更小的目的。
[Abstract]:Objective to observe the characteristics of superior trochlear artery (SCA) and its relationship with skin and frontal muscle. Based on this, a modified paraphalar median flap with little frontal muscle was designed and nasal reconstruction was performed. Methods Seven adult cadavers were dissected from the frontal part (12 superior trochlear arteries). The location, diameter and length of the superior trochlear artery were recorded with the superior orbital margin and the anterior median line as reference points. The hierarchical relationship with the frontal muscle and skin, the branches and the anastomosis with the superior orbital artery and the frontal branch of the superficial temporal artery. According to the anatomical results, a modified paraphalar median flap with only a small amount of frontal muscle pedicle was designed in clinic to perform nasal reconstruction. The level of superior trochlear artery, the survival of the flap, and the color, shape, alar, tip of the nose were observed during the operation. Nasal column and patients' satisfaction with reconstructed nose. Results all the superior trochlear arteries were generated from the superior notch of the trochlear, and the point was (1.33 卤0.14) cm from the anterior median line. The external diameter of the issuing point was (1.28 卤0.22) mm. The lateral angle between the main trunk and the superior orbital margin was 82 degrees and the total length was (5.98 卤0.64) cm. At the level of (0.93 卤0.23) cm above the supraorbital margin and the level of the supraorbital margin, the main trunk can be divided into three sections: the first spontaneous exiting point to the supraorbital margin, the superior trochlear artery between the orbicularis oculi muscle and the frowning muscle; The second segment was from the supraorbital margin to the supraorbital margin (0.93 卤0.23) cm. The superior trochlear artery traverses the frontalis muscle at the level of (1.21 卤0.15) cm from the anterior median line to the surface of the frontalis, and the third segment runs from (0.93 卤0.23) cm above the superior orbital margin to the end point. The superior trochlear artery was shallowly located in the superficial subcutaneous layer, and gradually shallowened to the level of (1.26 卤0.20) cm above the supraorbital margin of the superior trochlear artery in 5 cadavers (8 sides). Bilateral superior trochlear artery and superior trochlear artery were anastomosed with ipsilateral superior orbital artery and frontal branch of superficial temporal artery. There were no obvious axial-shaped superior trochlear artery branches found in the frontal muscle. Three cases of nasal reconstruction were performed with the modified paraphalar median flap. It was found that there was a branch of superior trochlear artery in the subcutaneous region of the forehead. The skin temperature of the flap was normal and the skin temperature of the flap was normal, and the flap survived in 2 cases. There was a small amount of necrosis around the flap in 1 case, and self-healing after dressing change. After 6-9 months follow up, the skin flap had no contracture, normal color, nasal dorsal, nasal wing, nasal tip, nasal column shape thickness close to normal, nasal lateral wall is not bloated, patients are satisfied with the operation results. Conclusion the superior trochlear artery passes through the frontal muscle from the supraorbital margin horizontally and runs in the form of trunk between the subcutaneous tissue and the frontal muscle layer, and gradually shrunk. Along the way, the frontalis muscle branch and the cutaneous branch of the trochlear artery are fed with the frontal muscle and the forehead skin, respectively. Therefore, we can design a paraphoral median flap with only a small number of frontal muscles in pedicle to perform nasal reconstruction to make the reconstructed nose more in line with the aesthetic standard and to reduce the injury of the prefrontal donor area.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R322;R765.9

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