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  本文選題：穿支皮瓣 + 應(yīng)用解剖��； 參考：《南華大學(xué)》2010年碩士論文

【摘要】： 第一章股外側(cè)穿支皮瓣的應(yīng)用解剖研究 目的為股外側(cè)穿支皮瓣的臨床應(yīng)用提供解剖學(xué)依據(jù)。 方法選取6側(cè)新鮮中國成人髖關(guān)節(jié)離斷標(biāo)本,經(jīng)股動脈插管灌注紅色乳膠,標(biāo)本解凍48小時后解剖,5側(cè)觀測股外側(cè)中下部皮膚穿支數(shù)目、分布、蒂長與外徑, 1側(cè)標(biāo)本模擬股外側(cè)穿支皮瓣手術(shù)。測量數(shù)據(jù)采用SPSS11.0統(tǒng)計軟件分析處理。 結(jié)果本組標(biāo)本在股外側(cè)中下部共觀測皮膚穿支19支,平均每側(cè)3.8±1.3支。穿支主要來源于股深動脈第3穿動脈,部分來源于膝上外側(cè)動脈及股深動脈第2、4穿動脈,股深動脈第3穿動脈皮穿支于腓骨小頭上13.8±1.5cm淺出深筋膜,膝上外側(cè)動脈皮穿支于腓骨小頭上8.6±1.3cm淺出深筋膜,皮膚穿支在穿深筋膜平面外徑0.7±0.2mm。股深動脈第3穿動脈血管蒂外徑1.9±0.2mm,蒂長12.2±0.6cm;膝上外側(cè)動脈起始部外徑1.5±0.2mm,蒂長6.8±1.1cm。股深動脈穿動脈與膝上外側(cè)動脈的穿支分支相互吻合成網(wǎng)。 結(jié)論股外側(cè)穿支血管出現(xiàn)恒定,有較粗的血管外徑,攜帶源動脈能獲得較長的血管蒂,具備游離移植及帶蒂轉(zhuǎn)移所要求的解剖學(xué)特點。 第二章股外側(cè)穿支皮瓣的臨床應(yīng)用研究 目的探討股外側(cè)穿支皮瓣修復(fù)四肢軟組織缺損的可行性與臨床療效。 方法結(jié)合術(shù)前彩超穿支定位,以腓骨小頭和股骨大轉(zhuǎn)子連線為軸心線,以腓骨小頭上方13.8±1.5cm處為皮瓣中心點根據(jù)創(chuàng)面形狀設(shè)計13例皮瓣修復(fù)四肢不同形狀創(chuàng)面。帶蒂轉(zhuǎn)移1例,游離移植12例,其中2例采用血管串聯(lián)吻合與股前外側(cè)皮瓣組合移植。 結(jié)果本組13例皮瓣,全部順利成活。術(shù)后隨訪3～6個月,皮瓣外形不臃腫,質(zhì)地柔軟,有彈性,色澤良好,未發(fā)生凍傷與潰瘍。供區(qū)無一例出現(xiàn)肌肉粘連或疤痕攣縮畸形導(dǎo)致的關(guān)節(jié)活動障礙。直接縫合的病例僅留線性疤痕,植皮修復(fù)者植皮區(qū)域飽滿無凹陷。 結(jié)論股外側(cè)穿支皮瓣具有穿支來源相對恒定、皮瓣薄而柔軟、外形較美觀、解剖分離相對簡單、手術(shù)創(chuàng)傷小等優(yōu)點,游離移植適合四肢中小型皮膚缺損創(chuàng)面修復(fù),帶蒂轉(zhuǎn)移適宜修復(fù)膝、乆部位創(chuàng)面,與股前外側(cè)穿支皮瓣組合移植適宜修復(fù)四肢大面積創(chuàng)面。
[Abstract]:Chapter 1: applied anatomy of lateral femoral perforator flap objective to provide anatomic basis for clinical application of lateral femoral perforator flap. Methods six fresh Chinese adult hip dissection specimens were perfused with red latex through femoral artery intubation. The number and distribution of perforating branches of the lateral middle and lower femoral skin were observed in 5 sides after thawing 48 hours after thawing. Pedicle length and external diameter, 1 side of the specimen mimic the lateral femoral perforator flap operation. The measured data were analyzed and processed by SPSS 11.0 statistical software. Results 19 perforating branches of the skin were observed in the middle and lower part of the lateral femoris, with an average of 3.8 鹵1.3 branches per side. The perforating branch was mainly derived from the third perforating artery of deep femoral artery, partly from the superior lateral genicular artery and the 2th perforating artery of deep femoral artery, and the cutaneous perforating branch of the third perforating artery of deep femoral artery from the superficial fascia of the fibula on 13. 8 鹵1.5cm. The cutaneous perforating branch of the superior lateral geniculate artery was on the fibula head 8.6 鹵1.3cm shallow out of the deep fascia, and the skin perforating branch was 0.7 鹵0.2 mm in diameter in the plane of perforating the deep fascia. The pedicle diameter of the third perforating artery of the deep femoral artery was 1.9 鹵0.2 mm, the pedicle length was 12.2 鹵0.6 cm, the external diameter of the lateral superior genicular artery was 1.5 鹵0.2 mm and the pedicle length was 6.8 鹵1.1 cm. The perforating branches of the deep femoral artery anastomosed with the perforating branches of the superior lateral genicular artery. Conclusion the lateral femoral perforating branch has a constant external diameter and a long pedicle with a long pedicle. It has the anatomical characteristics required for free transplantation and pedicle transfer. Chapter 2 the clinical application of lateral femoral perforator flap objective to investigate the feasibility and clinical effect of lateral femoral perforator flap in repairing soft tissue defect of extremities. Methods combined with preoperative localization of perforating branches by color Doppler ultrasound, 13 cases of limb wounds with different shapes were designed with fibula head and femoral great trochanter line as axis line, and 13 cases of skin flap center point at the top of fibula head as center point according to the shape of wound. Pedicle transfer was found in 1 case and free graft in 12 cases. Among them, 2 cases were transplanted with vascular series anastomosis combined with anterolateral femoral flap. Results all the 13 cases of flap survived successfully. Following up for 3 ~ 6 months, the skin flap was not bloated, soft, elastic, good color, no frostbite and ulceration. There was no joint movement disorder caused by muscle adhesion or scar contracture malformation in donor area. Direct suture only leaves a linear scar, and the skin graft area is full and hollow. Conclusion the lateral femoral perforator flap has the advantages of relatively constant perforating branch origin, thin and soft skin flap, beautiful appearance, relatively simple anatomical separation and small surgical trauma, etc. Free transplantation is suitable for repairing small and medium-sized skin defects in extremities. Pedicle transfer was suitable for repairing knee wounds, and combined transplantation with anterolateral femoral perforator flap was suitable for repairing large area wounds of extremities.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R322;R622

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