额颞部皮肤软组织静脉回流模式的解剖学研究和临床应用研究
发布时间：2018-08-03 15:45
【摘要】：背景：颞浅血管束为蒂的额部皮瓣常用于头面颈部组织缺损的修复,因其动脉血管解剖恒定、皮瓣组织丰富、供区隐蔽的特点,是整形外科最为常用的皮瓣之一。由于颞浅静脉分支与动脉伴行关系不确切,临床上存在皮瓣远端静脉回流不畅、部分坏死的情况,一定程度上限制了皮瓣在临床中的使用。另一方面,由于研究静脉回流的难度大于动脉供血,现有的研究手段及方法具有一定局限性,一定程度上限制了进一步的深入研究。为了完善以颞浅血管为蒂的额部皮瓣术式,避免术后静脉回流障碍的出现,有必要进一步详细研究额颞部局部静脉回流特点并总结规律。第一部分研究现有头面部标本的防腐及血管内灌注方法加以改进,并使用12具人类尸体标本采用分组对照的方法比较了三种不同的标本制备及血管内乳胶灌注方法,选出最适合于本研究项目的标本制备方法。第二部分研究使用18具人体头颅标本,对颞浅动脉流域内的额颞部皮肤进行详细的动静脉血管解剖研究,观察动脉及静脉分支在组织内的分支走行规律,总结这一区域内静脉回流模式。对颞浅动脉分支紧密伴行的细小附壁静脉的管径进行了测量及分类研究,提出了附壁静脉的分型和分支汇入点的保护措施,在此基础上应用静脉回流模式对临床上常见的几种皮瓣的设计进行分析,针对皮瓣出现静脉回流障碍的原因提出了皮瓣设计的改进原则。第三部分研究根据收集到的临床头面部DSA及CTA影像资料,对颞浅动脉流域内的额颞部皮肤进行详细的动静脉血管影像分析研究,观察动脉及静脉分支在组织内的分支走行规律,对解剖学研究所获得的静脉回流模式加以验证。研究发现影像学资料可以支持标本解剖学研究所获得的额颞部皮肤静脉回流模式,CTA检查可能更适合作为颞浅部皮瓣术前的影像学辅助检查。第四部分研究针对解剖研究的结果和临床观察,提出吻合远端动静脉血管束的手术方案以改善皮瓣远端静脉回流障碍。研究设计了两组共15例患者的病例对照研究,吻合血管组获得了全部成活的良好效果,而对照组则出现了不同程度的远端静脉淤血以及皮瓣部分坏死。研究结果初步证实了根据额颞部皮肤静脉回流特点所提出的皮瓣改进设计可以改善皮瓣的远端静脉回流。结论：额颞部皮肤的静脉回流具有明显的分区分层特性,各区域的静脉回流在不同层面相互沟通形成由浅到深的静脉回流网络。临床的皮瓣设计需考虑到这一区域静脉回流的特点并加以改进,可以扬长避短发挥以颞浅血管为蒂的额部皮瓣的最大效能。
[Abstract]:Background: the frontalis flap pedicled with superficial temporal vascular bundle is often used to repair the head and neck tissue defect. Because of its constant arterial anatomy, abundant flap tissue and hidden donor area, it is one of the most commonly used flap in plastic surgery. Because of the inexact relationship between the branches of superficial temporal vein and the accompanying artery, the distal venous drainage and partial necrosis of the flap exist in clinic, which limits the use of the flap in clinic to a certain extent. On the other hand, because the study of venous reflux is more difficult than that of arterial blood supply, the existing research methods and methods are limited to some extent, which limits the further research. In order to perfect the operation method of frontalis flap pedicled with superficial temporal blood vessel and avoid the obstruction of venous reflux after operation, it is necessary to study the characteristics of local venous reflux in frontotemporal region in detail and summarize the rule. In the first part, the methods of anticorrosion and intravascular perfusion of head and face specimens were improved, and three different methods of preparation and intravascular emulsion perfusion were compared using 12 human cadavers. The most suitable specimen preparation method for this research project was selected. In the second part, 18 human head specimens were used to study the vascular anatomy of the frontotemporal skin in the superficial temporal artery basin, and to observe the branches of the arteries and veins in the tissues. To summarize the pattern of intraregional venous reflux in this area. The diameters of small parietal veins closely accompanied by the branches of superficial temporal artery were measured and classified. The classification of the vein attached to the wall and the protective measures of the entrainment point of the branches were put forward. On the basis of this, the design of some common flaps in clinic was analyzed by using venous drainage mode, and the improved principle of flap design was put forward in view of the reasons for the obstruction of venous reflux. In the third part, according to the clinical data of DSA and CTA, the arteriovenous images of frontotemporal skin in superficial temporal artery watershed were analyzed in detail, and the branches of artery and vein in tissues were observed. The pattern of venous reflux obtained by the Anatomy Institute was verified. It is found that the imaging data can support the frontotemporal skin venous drainage pattern CTA which obtained from the anatomical study may be more suitable for the imaging auxiliary examination of superficial temporal flap before operation. In the fourth part, according to the results of anatomical study and clinical observation, the surgical scheme of distal vascular bundle anastomosis was put forward to improve the obstruction of distal venous reflux of the flap. A case-control study of 15 patients in two groups was carried out. The vascular anastomosis group achieved good results of survival, while the control group showed different degrees of distal venous congestion and partial necrosis of the flap. The results preliminarily confirmed that the improved design of the skin flap based on the characteristics of frontotemporal skin venous drainage can improve the distal venous drainage of the flap. Conclusion: the venous reflux in frontotemporal skin has obvious zonal stratification and the venous reflux in different regions communicates with each other on different levels to form a superficial to deep venous reflux network. The clinical design of the flap needs to take into account the characteristics of the regional venous reflux and be improved to maximize the effectiveness of the frontalis flap pedicled with superficial temporal vessels.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R622
，
本文编号：2162209
[Abstract]:Background: the frontalis flap pedicled with superficial temporal vascular bundle is often used to repair the head and neck tissue defect. Because of its constant arterial anatomy, abundant flap tissue and hidden donor area, it is one of the most commonly used flap in plastic surgery. Because of the inexact relationship between the branches of superficial temporal vein and the accompanying artery, the distal venous drainage and partial necrosis of the flap exist in clinic, which limits the use of the flap in clinic to a certain extent. On the other hand, because the study of venous reflux is more difficult than that of arterial blood supply, the existing research methods and methods are limited to some extent, which limits the further research. In order to perfect the operation method of frontalis flap pedicled with superficial temporal blood vessel and avoid the obstruction of venous reflux after operation, it is necessary to study the characteristics of local venous reflux in frontotemporal region in detail and summarize the rule. In the first part, the methods of anticorrosion and intravascular perfusion of head and face specimens were improved, and three different methods of preparation and intravascular emulsion perfusion were compared using 12 human cadavers. The most suitable specimen preparation method for this research project was selected. In the second part, 18 human head specimens were used to study the vascular anatomy of the frontotemporal skin in the superficial temporal artery basin, and to observe the branches of the arteries and veins in the tissues. To summarize the pattern of intraregional venous reflux in this area. The diameters of small parietal veins closely accompanied by the branches of superficial temporal artery were measured and classified. The classification of the vein attached to the wall and the protective measures of the entrainment point of the branches were put forward. On the basis of this, the design of some common flaps in clinic was analyzed by using venous drainage mode, and the improved principle of flap design was put forward in view of the reasons for the obstruction of venous reflux. In the third part, according to the clinical data of DSA and CTA, the arteriovenous images of frontotemporal skin in superficial temporal artery watershed were analyzed in detail, and the branches of artery and vein in tissues were observed. The pattern of venous reflux obtained by the Anatomy Institute was verified. It is found that the imaging data can support the frontotemporal skin venous drainage pattern CTA which obtained from the anatomical study may be more suitable for the imaging auxiliary examination of superficial temporal flap before operation. In the fourth part, according to the results of anatomical study and clinical observation, the surgical scheme of distal vascular bundle anastomosis was put forward to improve the obstruction of distal venous reflux of the flap. A case-control study of 15 patients in two groups was carried out. The vascular anastomosis group achieved good results of survival, while the control group showed different degrees of distal venous congestion and partial necrosis of the flap. The results preliminarily confirmed that the improved design of the skin flap based on the characteristics of frontotemporal skin venous drainage can improve the distal venous drainage of the flap. Conclusion: the venous reflux in frontotemporal skin has obvious zonal stratification and the venous reflux in different regions communicates with each other on different levels to form a superficial to deep venous reflux network. The clinical design of the flap needs to take into account the characteristics of the regional venous reflux and be improved to maximize the effectiveness of the frontalis flap pedicled with superficial temporal vessels.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R622
，
本文编号：2162209
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