本文選題：下部前鋸肌 + 側(cè)胸皮瓣�。� 參考：《安徽醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的:研究前鋸肌尤其是其下部肌肉的血供、神經(jīng)及其側(cè)胸皮瓣的解剖學(xué)特點(diǎn),介紹以胸背動(dòng)脈前鋸肌支為蒂的側(cè)胸皮瓣的臨床應(yīng)用。 方法:解剖觀測(cè)8具(16側(cè))尸體標(biāo)本的前鋸肌形態(tài)、胸背動(dòng)脈、胸長神經(jīng)、前鋸肌支的走行、分支和分布特征。觀測(cè)前鋸肌支和肋間動(dòng)脈穿支對(duì)側(cè)胸壁皮膚的血供,及其兩者在下部前鋸肌肉內(nèi)吻合情況。其中在1例新鮮尸體上,注入藍(lán)色墨汁,觀測(cè)側(cè)胸壁皮膚染色范圍。在解剖研究的基礎(chǔ)上,應(yīng)用以胸背動(dòng)脈前鋸肌支為蒂的帶下部前鋸肌的側(cè)胸皮瓣游離或帶蒂移植修復(fù)肢體皮膚軟組織缺損7例。 結(jié)果:下部前鋸肌的血供主要來自胸背動(dòng)脈的前鋸肌支,平均直徑為(1.7±0.4)mm,以前鋸肌支為蒂的肌皮側(cè)胸皮瓣蒂長為(4.2±1.1)cm。覆蓋下部前鋸肌的側(cè)胸皮瓣血供主要來自肋間動(dòng)脈穿支和前鋸肌支皮支,兩分支之間在下部前鋸肌內(nèi)存在著豐富的交通吻合。臨床應(yīng)用游離下部前鋸肌側(cè)胸皮瓣6例,帶蒂轉(zhuǎn)移修復(fù)胸前壁皮膚缺損創(chuàng)面1例,7例均成活。側(cè)胸皮瓣切除面積最小4.5cm×8cm,最大10.5cm×15cm。隨訪6～10個(gè)月,皮瓣外形均滿意,無需二次手術(shù)修薄皮瓣。供區(qū)隱蔽,無前鋸肌功能障礙。 結(jié)論:本研究為前鋸肌下部側(cè)胸皮瓣安全可靠地切取提供解剖依據(jù)。下部前鋸肌側(cè)胸皮瓣血管蒂長、解剖位置恒定、血運(yùn)豐富,切取皮瓣面積較大。在修復(fù)肢體皮膚軟組織缺損應(yīng)用方面具有很好的前景。
[Abstract]:Objective: to study the blood supply, nerve and lateral thoracic flap anatomy of serratus anterior muscle, especially its lower muscle, and to introduce the clinical application of lateral thoracic flap pedicled with anterior serratus muscle branch of dorsal thoracic artery. Methods: the morphology of serratus anterior, the dorsal thoracic artery, the long thoracic nerve and the branches, branches and distribution of serratus anterior muscle in 8 cadavers (16 sides) were observed. The blood supply of the contralateral chest wall of the anterior serratus branch and intercostal artery perforating branch and their anastomosis in the lower anterior serrated muscle were observed. Blue ink was injected into one fresh corpse and the extent of skin staining on the lateral chest wall was observed. On the basis of anatomical study, 7 cases of soft tissue defects of extremities were repaired by free or pedicled lateral thoracic flap pedicled with inferior serratus anterior serratus branch of thoracic dorsal artery. Results: the blood supply of the inferior serratus came mainly from the anterior serratus branch of the dorsal thoracic artery, with an average diameter of 1.7 鹵0.4 mm, and the pedicle length of the pedicle of the musculocutaneous skin flap pedicled with the anterior serratus branch was 4.2 鹵1.1 cm. The blood supply of the lateral thoracic flap covering the lower anterior serratus mainly comes from the perforating branch of intercostal artery and the cutaneous branch of the anterior serratus branch, and there is abundant traffic anastomosis between the two branches in the inferior anterior serratus muscle. Clinical application of free lower serratus lateral thoracic flap in 6 cases, pedicle transfer repair of chest anterior wall skin defect in 1 case, 7 cases survived. The area of lateral thoracic flap was the smallest 4.5cm 脳 8 cm, and the maximum of 10.5cm 脳 15 cm. Follow up for 6 ~ 10 months showed that the skin flap was satisfactory in appearance and no need for secondary operation to repair the skin flap. The donor area was concealed and there was no dysfunction of serratus anterior muscle. Conclusion: this study provides anatomic basis for the safe and reliable excision of the lower serratus anterior thoracocutaneous flap. The proximal serratus anterior thoracic flap has long pedicle, constant anatomical position, abundant blood supply, and larger area of skin flap. It has a good prospect in repairing limb skin and soft tissue defect.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R322.1

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