本文選題：頦下血管 + 頦下皮瓣��； 參考：《中國協(xié)和醫(yī)科大學》2007年碩士論文

【摘要】： 頦下皮瓣解剖學及臨床應(yīng)用的研究 頦下皮瓣用于臨床已有10多年的歷史，，它位于頦下區(qū)，有可靠的動脈供應(yīng)及靜脈回流，該皮瓣可以以多種形式應(yīng)用于臨床。皮瓣成活率達93.09％，常見的并發(fā)癥為皮瓣壞死和下頜緣神經(jīng)損傷。但目前國內(nèi)尚缺乏詳盡的應(yīng)用解剖學研究，并且在臨床應(yīng)用時，有并發(fā)癥發(fā)生，因此有必要進行更詳細的解剖學研究以指導臨床實踐。 【目的】 (1)頦下區(qū)皮膚組織學特點決定了頦下皮瓣是修復面部及口腔缺損的可用的皮瓣之一。本研究通過對成人尸體的解剖學研究，為頦下皮瓣的臨床應(yīng)用提供更加詳盡的形態(tài)學和解剖學依據(jù)，從而達到減少臨床應(yīng)用時并發(fā)癥的發(fā)生的目的。(2)通過將上述解剖結(jié)果應(yīng)用于臨床，觀測臨床應(yīng)用頦下皮瓣時的血運及成活情況，評價該皮瓣的安全可靠程度及臨床應(yīng)用前景。 【方法】 (1)將14例甲醛固定的成人尸體標本，行紅色或黑色乳膠灌注處理，制成透明標本和灌注標本；重點觀察并測量頦下血管的起始、走行、分支、體表投影及吻合支的情況，以及其與周圍神經(jīng)血管的相互關(guān)系；對測量數(shù)據(jù)進行描述性統(tǒng)計分析；并對尸體左右兩側(cè)的重點指標進行t檢驗。(2)通過臨床病例觀察，總結(jié)頦下皮瓣的臨床應(yīng)用經(jīng)驗。 【結(jié)果】 (1)頦下皮瓣由頦下血管供血，頦下動脈是面動脈的恒定分支。面動脈在距下頜骨下緣7.23±2.65 mm、下頜角前19.34±5.06 mm和在距其起點27.16±1.21 mm處時發(fā)出的頦下動脈，頦下動脈的出現(xiàn)率100％。頦下動脈起點處的直徑為1.86±0.96 mm，頦下靜脈的直徑為1.97±0.73 mm。經(jīng)過t檢驗，表明左右兩側(cè)數(shù)據(jù)沒有顯著性差異。(2)頦下皮瓣血運可靠，靜脈回流充分，可順行或逆行轉(zhuǎn)位，或經(jīng)皮膚軟組織擴張器擴張后，用于修復面部、口腔的缺損。手術(shù)后皮瓣存活良好，皮瓣的顏色、質(zhì)地良好，供區(qū)瘢痕隱蔽，患者滿意。 【結(jié)論】 (1)頦下動脈是支配頦下區(qū)的恒定而可靠的動脈，頦下動脈起點及走行相對較固定；頦下靜脈位置恒定，與頦下動脈伴行；鑒于頦下區(qū)有可靠的動脈血液供應(yīng)及靜脈回流，故可設(shè)計出多種形式的皮瓣。(2)該皮瓣具有蒂長恒定、血供可靠、切取方便、帶有感覺神經(jīng)、不犧牲主干血管及供區(qū)隱蔽、可一期直接縫合等優(yōu)點。(3)該皮瓣可跨越中線制備成逆行軸型皮瓣，亦可通過埋置皮膚軟組織擴張器預制成擴張后皮瓣，修復面部及口腔缺損。因此臨床上可作為修復面部及口腔缺損的常規(guī)皮瓣。
[Abstract]:Study on anatomy and clinical application of submental flapThe submental flap has been used in clinic for more than 10 years. It is located in the submental region and has reliable arterial supply and venous reflux. The flap can be used in clinical practice in many forms.The survival rate of flap was 93.099.The common complications were flap necrosis and mandibular nerve injury.However, there are few detailed applied anatomy studies in China, and there are complications in clinical application, so it is necessary to conduct more detailed anatomical research to guide clinical practice.[purpose]1) the submental skin flap is one of the useful flaps for repairing facial and oral defects.This study provides more detailed morphological and anatomical basis for clinical application of submental flap through anatomical study of adult cadavers.By applying the above anatomical results to clinic, the blood circulation and survival of the submental flap were observed, and the safety and reliability of the flap and the prospect of clinical application were evaluated.[methods]14 formaldehyde-fixed adult cadavers were perfused with red or black latex to make transparent specimens and perfused specimens. The origin, movement, branch, projection of body surface and anastomotic branches of submental vessels were observed and measured.And its relationship with peripheral nerve and blood vessels; the descriptive statistical analysis of the measured data; and the t test on the left and right sides of the cadaver.) the clinical application experience of the submental flap was summarized through clinical case observation.[results]1) the submental flap is supplied by submental vessels, and the submental artery is a constant branch of the facial artery.The occurrence rate of the inferior mental artery was 100% when the facial artery was 7.23 鹵2.65 mm from the lower margin of the mandible, 19.34 鹵5.06 mm before the mandibular angle and 27.16 鹵1.21 mm from its starting point.The diameter of the submental artery and the submental vein were 1.86 鹵0.96 mm and 1.97 鹵0.73 mm respectively.T test showed that there was no significant difference between the left and right sides. 2) the submental flap had reliable blood flow, sufficient venous reflux, and could be used to repair the defects of the face and mouth after the expansion of the skin and soft tissue expander or the anterograde or retrograde transposition.After operation, the flap survived well, the color and texture of the flap were good, the donor scar was concealed, and the patient was satisfied.[conclusion]1) the submental artery is a constant and reliable artery that innervates the submental area, and the starting point and course of the submental artery are relatively fixed; the position of the submental vein is constant and accompanied by the submental artery; and since there is a reliable arterial blood supply and venous reflux in the submental region,The flap has the advantages of constant pedicle length, reliable blood supply, convenient removal, sensory nerve, no sacrificing of the main blood vessels and concealment of the donor area.The flap can be made into a retrograde axial flap across the midline or prefabricated into an expanded skin flap by embedding a soft tissue expander to repair the defects of the face and mouth.Therefore, it can be used as a routine flap to repair facial and oral defects.
【學位授予單位】：中國協(xié)和醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2007
【分類號】：R622;R322

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