腹壁下动脉穿支螺旋桨皮瓣的设计改良和临床应用

发布时间：2018-03-04 02:19

本文选题：螺旋桨皮瓣　切入点：穿支皮瓣　出处：《北京协和医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的腹壁下动脉穿支皮瓣主要作为一个游离皮瓣,用于自体组织乳房再造；作为一个带蒂皮瓣,主要以腹壁下动脉主干为蒂；广泛的腹直肌剥离会造成严重的供瓣区损伤；本研究介绍单纯以腹壁下动脉穿支为蒂的腹部螺旋桨皮瓣的临床应用。方法自2010年3月至2014年12月,共有10位患者实施了以腹壁下动脉穿支为蒂的螺旋桨皮瓣,其中男、女各5例,年龄5-67岁,平均年龄22.8岁；病因学包括恶性肿瘤5例,烧伤后瘢痕挛缩5例。缺损的位置包括腹部(n=6)、腰腹部(n=3)和胸腹部(n=1)。所有皮瓣的穿支血管蒂放置于皮瓣的偏心位置,皮瓣旋转一定角度后,皮瓣较大的部分用于修复缺损,而较小的部分用于协助供瓣区的关闭。结果缺损的大小8x5cm-30x9cm,平均大小为20.41x9.53cm;皮瓣大小为13x5cm-30×10cm,平均大小为22x8.47cm。血管蒂长度为2.5-5.5cm,平均4.15cm。6个皮瓣旋转180度,4个皮瓣旋转120度。其中横向设计的皮瓣6个,斜向设计的皮瓣3个,垂直设计的皮瓣1个。手术后8个皮瓣全部成活；有2个旋转1800的皮瓣出现了皮瓣尖端的部分坏死,所有皮瓣供瓣区均直接拉拢缝合,手术后没有发现因为皮瓣的切取而导致的肌肉功能障碍或腹壁薄弱。结论以腹壁下动脉穿支为蒂的螺旋桨皮瓣无需切断腹壁下动脉主干,仅在穿支血管于深筋膜上的发出点处对腹直肌进行小范围的剥离。因此,与传统的以腹壁下动脉主干为蒂的游离皮瓣或带蒂皮瓣相比,降低了供瓣区损害；对于腹部、腰部的皮肤软组织缺损,腹壁下动脉穿支蒂螺旋桨皮瓣是一种值得考虑的修复重建方法。
[Abstract]:Objective the perforating branch flap of inferior abdominal artery is mainly used as a free flap for reconstruction of autologous breast, as a pedicled flap with the main trunk of the inferior abdominal artery as the pedicle, and extensive rectus abdominis dissection will cause serious injury to the donor flap area. This study introduced the clinical application of propeller flap pedicled solely with the perforating branch of inferior abdominal artery. Methods from March 2010 to December 2014, 10 patients (male) were treated with propeller flap pedicled with perforating branch of inferior abdominal artery. The average age was 22.8 years, and the etiology included malignant tumor in 5 cases. Cicatricial contracture was found in 5 cases after burn. The location of the defect included abdominal nipple (6), waist and abdomen (3) and chest and abdomen (1). The perforating branches of all flaps were placed in the eccentric position of the flap. The larger part of the flap was used to repair the defect after the flap rotated at a certain angle. Results the defect size was 8x5cm-30x9cm, the average size was 20.41x9.53cm, the flap size was 13x5cm-30 脳 10cm, the average size was 22x8.47cm. The pedicle length was 2.5-5.5cm, the average 4.15cm.6 flaps rotated 180 degrees, 4 flaps rotated 120 degrees. Middle transverse design of 6 flaps, There were 3 oblique flaps and 1 vertical flaps. All the 8 flaps survived after operation. Two rotating-1800 flaps showed partial necrosis at the tip of the flaps, and all the flap donor areas were closed and sutured directly. No muscle dysfunction or weak abdominal wall was found after operation. Conclusion the propeller flap pedicled with the perforating branch of the inferior abdominal artery does not need to cut off the main trunk of the inferior abdominal artery. The rectus abdominis muscle is stripped only at the point at which the perforating vessel is issued on the deep fascia. Therefore, compared with the traditional free flap or pedicled flap pedicled with the main trunk of the inferior abdominal artery, the damage to the donor flap area is reduced; in the case of abdomen, The skin and soft tissue defect in the waist and the pedicled propeller flap pedicled with the perforating branch of the inferior abdominal artery are worthy of consideration.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.3

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