股前外侧穿支皮瓣的应用解剖与临床研究

发布时间：2019-02-11 17:48

【摘要】： 第一章股前外侧穿支皮瓣的应用解剖研究目的了解股前外侧穿支血管的数目、类型、起源、外径、走行及分布特性,以指导股前外侧穿支皮瓣的设计和切取。方法选择6侧红色乳胶灌注的新鲜成人下肢标本进行显微解剖,观察和测量股前外侧穿支血管的数目、类型、外径、走行及分布特性。结果本组6侧标本共发现0.5mm穿动脉22支,每侧平均3.6支;18支(81.8%)来自降支,4支(18.1%)来自横支;肌皮穿支16支(72.7%)、肌间隙穿支6支(27.3%);旋股外侧动脉降支(或横支)起始处至穿支在浅筋膜内分支的长度为17.5±3.1cm(14.5cm～22.5cm)、穿支起始处至穿支在浅筋膜内分支处的长度为7.6±4.1cm(2.3cm～12.5cm)、浅筋膜内穿支长度为2.7±0.5cm(2.0～3.5 cm);旋股外侧动脉降支(或横支)起始处的外径为2.8±0.5mm(2.1mm～3.5mm)、穿支起始处外径为1.9±0.8mm(1.4mm～2.7mm)、穿深筋膜平面的外径为1.5±0.1mm(1.2mm～1.6mm)。穿支经穿阔筋膜后在浅筋膜和皮下呈“树枝状”分布,相邻穿支之间存在粗大的交通支。结论股前外侧穿支血管具有解剖恒定、血管蒂长、外径粗大、直接供养皮肤而不依赖肌肉和深筋膜等特性,具备制作股前外侧穿支皮瓣的解剖学基础;降支与横支及其各级分支构成的血管体区特点具备设计Flow-through、联体、嵌合、组合ALTPF等术式的解剖学基础。第二章股前外侧穿支皮瓣的临床研究目的探讨股前外侧穿支皮瓣移植的临床疗效和Flow-through、联体、嵌合、组合移植的可行性。方法选择2007年10月至2010年1月收治的四肢皮肤软组织缺损48例和阴囊湿疹癌1例,根据创面的不同特点分别采用单纯股前外侧穿支皮瓣游离移植、带血管蒂移位、Flow-through、联体、嵌合或组合移植修复。术后3个月、6个月、9个月和12个月随访,观察皮瓣外形、血运、颜色、修复肢体的活动功能、皮瓣供区外观与功能情况。结果本组49例股前外侧穿支皮瓣中,47例顺利成活,2例术后发生静脉危象,经探查1例为皮瓣下血肿、1例为静脉栓塞,分别行血肿清除、血栓取出,皮瓣成活。本组无一例发生感染,43例皮瓣获一期愈合,6例皮瓣伤口延迟愈合,经换药2-3w后闭合。术后随访3月-24月(平均12个月),皮瓣供区仅遗留线性瘢痕,股四头肌肌力正常,膝关节活动无影响,3例(6.1%)出现感觉异常;受区外观平整、颜色正常、质地好,仅2例(4%)皮瓣稍显臃肿,2例术后因烤火烫伤遗留疤痕。结论股前外侧穿支皮瓣可获得最佳的受区修复效果,最大限度减少皮瓣供区的损害,是修复四肢体表创面的理想皮瓣;采用Flow-through、联体、嵌合、组合等术式移植安全可行,拓展了股前外侧穿支皮瓣的适应症。
[Abstract]:Chapter 1 Anatomical study of the anterolateral femoral perforator flap objective to understand the number, type, origin, external diameter, walking and distribution characteristics of the anterolateral femoral perforator flap in order to guide the design and removal of the anterolateral femoral perforator flap. Methods A total of 6 fresh adult lower extremity specimens perfused with red latex were dissected to observe and measure the number, type, diameter, path and distribution of anterolateral femoral perforating vessels. Results A total of 22 perforating arteries of 0.5mm were found in 6 sides, with an average of 3.6 branches on each side, 18 (81.8%) from the descending branch and 4 (18.1%) from the transverse branch. 16 (72.7%) cutaneous perforators and 6 (27.3%) intermuscular perforators; The length of the descending branch (or transverse branch) of the lateral circumflex femoral artery to the branch of the perforating branch in the superficial fascia was 17. 5 卤3.1cm (14.5cm~22.5cm). The length from the perforating branch to the perforating branch in the superficial fascia was 7.6 卤4.1cm (2.3cm~12.5cm), and the length of the perforating branch in the superficial fascia was 2.7 卤0.5cm (2.0 卤3.5 cm);). The external diameter of descending branch (or transverse branch) of lateral femoral circumflex artery was 2.8 卤0.5mm (2.1mm~3.5mm) and that of perforating branch was 1.9 卤0.8mm (1.4mm~2.7mm). The external diameter of the deep fascia plane was 1. 5 卤0.1mm (1.2mm~1.6mm). The perforating branches were distributed in the superficial fascia and subcutaneously as "dendritic" after penetrating through the fascia lata, and there were thick communicating branches between the adjacent perforating branches. Conclusion the anterolateral femoral perforating branch has the characteristics of constant anatomy, long pedicle, wide external diameter, direct support of skin and no reliance on muscle and deep fascia, and has the anatomical basis for making anterolateral femoral perforating branch flap. The characteristics of the vascular body area of descending branch and transverse branch and its branches have the anatomical basis for designing Flow-through, conjoined, chimeric and combined ALTPF. Chapter 2 Clinical study of anterolateral femoral perforator flap objective to investigate the clinical effect of anterolateral femoral perforator flap transplantation and the feasibility of Flow-through, conjoined, chimeric and combined transplantation. Methods from October 2007 to January 2010, 48 cases of skin and soft tissue defects of extremities and 1 case of scrotal eczema carcinoma were treated. According to the different characteristics of the wound, the skin flap was transplanted with the pedicle of vascular pedicle, Flow-through,. Conjoined, chimeric, or combined graft repair. The flaps were followed up for 3 months, 6 months, 9 months and 12 months after operation. The shape, blood supply, color of the flap, the function of the limb, the appearance and function of the donor area of the flap were observed. Results among 49 cases of anterolateral femoral perforator flap, 47 cases survived successfully, 2 cases had venous crisis after operation, 1 case was subflap hematoma, 1 case was venous embolism, respectively, hematoma was removed, thrombus was removed and flap survived. There was no infection in this group. 43 cases of skin flap healed in one stage, 6 cases of flap wound healed delayed, and closed after changing dressing for 2 to 3 weeks. Follow-up for 3 months to 24 months (mean 12 months) showed that only linear scar was left in the flap donor area, quadriceps femoris muscle strength was normal, knee joint movement was not affected, and 3 cases (6.1%) had abnormal sensation. The skin flap of 2 cases (4%) was slightly bloated, and 2 cases were scarred by burning and scalding after operation. Conclusion the anterolateral femoral perforator flap can obtain the best repair effect of the recipient area and minimize the damage of the donor area of the flap. It is an ideal flap for repairing the wound of the limb surface. Flow-through, conjoined, chimeric and combined transplants were safe and feasible, and the indications of anterolateral femoral perforator flap were expanded.
【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

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