股外侧穿支皮瓣的应用解剖与临床研究

发布时间：2018-07-09 17:21

本文选题：穿支皮瓣 + 应用解剖　；参考：《南华大学》2010年硕士论文

【摘要】： 第一章股外侧穿支皮瓣的应用解剖研究目的为股外侧穿支皮瓣的临床应用提供解剖学依据。方法选取6侧新鲜中国成人髋关节离断标本,经股动脉插管灌注红色乳胶,标本解冻48小时后解剖,5侧观测股外侧中下部皮肤穿支数目、分布、蒂长与外径, 1侧标本模拟股外侧穿支皮瓣手术。测量数据采用SPSS11.0统计软件分析处理。结果本组标本在股外侧中下部共观测皮肤穿支19支,平均每侧3.8±1.3支。穿支主要来源于股深动脉第3穿动脉,部分来源于膝上外侧动脉及股深动脉第2、4穿动脉,股深动脉第3穿动脉皮穿支于腓骨小头上13.8±1.5cm浅出深筋膜,膝上外侧动脉皮穿支于腓骨小头上8.6±1.3cm浅出深筋膜,皮肤穿支在穿深筋膜平面外径0.7±0.2mm。股深动脉第3穿动脉血管蒂外径1.9±0.2mm,蒂长12.2±0.6cm;膝上外侧动脉起始部外径1.5±0.2mm,蒂长6.8±1.1cm。股深动脉穿动脉与膝上外侧动脉的穿支分支相互吻合成网。结论股外侧穿支血管出现恒定,有较粗的血管外径,携带源动脉能获得较长的血管蒂,具备游离移植及带蒂转移所要求的解剖学特点。第二章股外侧穿支皮瓣的临床应用研究目的探讨股外侧穿支皮瓣修复四肢软组织缺损的可行性与临床疗效。方法结合术前彩超穿支定位,以腓骨小头和股骨大转子连线为轴心线,以腓骨小头上方13.8±1.5cm处为皮瓣中心点根据创面形状设计13例皮瓣修复四肢不同形状创面。带蒂转移1例,游离移植12例,其中2例采用血管串联吻合与股前外侧皮瓣组合移植。结果本组13例皮瓣,全部顺利成活。术后随访3～6个月,皮瓣外形不臃肿,质地柔软,有弹性,色泽良好,未发生冻伤与溃疡。供区无一例出现肌肉粘连或疤痕挛缩畸形导致的关节活动障碍。直接缝合的病例仅留线性疤痕,植皮修复者植皮区域饱满无凹陷。结论股外侧穿支皮瓣具有穿支来源相对恒定、皮瓣薄而柔软、外形较美观、解剖分离相对简单、手术创伤小等优点,游离移植适合四肢中小型皮肤缺损创面修复,带蒂转移适宜修复膝、乆部位创面,与股前外侧穿支皮瓣组合移植适宜修复四肢大面积创面。
[Abstract]:Chapter 1: applied anatomy of lateral femoral perforator flap objective to provide anatomic basis for clinical application of lateral femoral perforator flap. Methods six fresh Chinese adult hip dissection specimens were perfused with red latex through femoral artery intubation. The number and distribution of perforating branches of the lateral middle and lower femoral skin were observed in 5 sides after thawing 48 hours after thawing. Pedicle length and external diameter, 1 side of the specimen mimic the lateral femoral perforator flap operation. The measured data were analyzed and processed by SPSS 11.0 statistical software. Results 19 perforating branches of the skin were observed in the middle and lower part of the lateral femoris, with an average of 3.8 卤1.3 branches per side. The perforating branch was mainly derived from the third perforating artery of deep femoral artery, partly from the superior lateral genicular artery and the 2th perforating artery of deep femoral artery, and the cutaneous perforating branch of the third perforating artery of deep femoral artery from the superficial fascia of the fibula on 13. 8 卤1.5cm. The cutaneous perforating branch of the superior lateral geniculate artery was on the fibula head 8.6 卤1.3cm shallow out of the deep fascia, and the skin perforating branch was 0.7 卤0.2 mm in diameter in the plane of perforating the deep fascia. The pedicle diameter of the third perforating artery of the deep femoral artery was 1.9 卤0.2 mm, the pedicle length was 12.2 卤0.6 cm, the external diameter of the lateral superior genicular artery was 1.5 卤0.2 mm and the pedicle length was 6.8 卤1.1 cm. The perforating branches of the deep femoral artery anastomosed with the perforating branches of the superior lateral genicular artery. Conclusion the lateral femoral perforating branch has a constant external diameter and a long pedicle with a long pedicle. It has the anatomical characteristics required for free transplantation and pedicle transfer. Chapter 2 the clinical application of lateral femoral perforator flap objective to investigate the feasibility and clinical effect of lateral femoral perforator flap in repairing soft tissue defect of extremities. Methods combined with preoperative localization of perforating branches by color Doppler ultrasound, 13 cases of limb wounds with different shapes were designed with fibula head and femoral great trochanter line as axis line, and 13 cases of skin flap center point at the top of fibula head as center point according to the shape of wound. Pedicle transfer was found in 1 case and free graft in 12 cases. Among them, 2 cases were transplanted with vascular series anastomosis combined with anterolateral femoral flap. Results all the 13 cases of flap survived successfully. Following up for 3 ~ 6 months, the skin flap was not bloated, soft, elastic, good color, no frostbite and ulceration. There was no joint movement disorder caused by muscle adhesion or scar contracture malformation in donor area. Direct suture only leaves a linear scar, and the skin graft area is full and hollow. Conclusion the lateral femoral perforator flap has the advantages of relatively constant perforating branch origin, thin and soft skin flap, beautiful appearance, relatively simple anatomical separation and small surgical trauma, etc. Free transplantation is suitable for repairing small and medium-sized skin defects in extremities. Pedicle transfer was suitable for repairing knee wounds, and combined transplantation with anterolateral femoral perforator flap was suitable for repairing large area wounds of extremities.
【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;R622

【参考文献】