上臂內(nèi)側(cè)皮瓣的解剖學(xué)研究及臨床應(yīng)用
發(fā)布時間：2018-11-26 11:31
【摘要】： 目的:本研究旨在通過對上臂內(nèi)側(cè)皮瓣深筋膜淺層以上的血管微巨解剖研究,為臨床應(yīng)用上臂內(nèi)側(cè)擴張皮瓣提供理論指導(dǎo),并應(yīng)用上臂內(nèi)側(cè)皮瓣帶蒂轉(zhuǎn)移修復(fù)面頸部缺損。 方法:新鮮成人上肢標本10側(cè),左右各半,乳膠灌注血管。四倍放大鏡下由淺入深進行解剖,觀察淺筋膜層內(nèi)血管的吻合情況及吻合支的數(shù)量,皮動脈穿出深筋膜的位置。并總結(jié)臨床應(yīng)用該皮瓣擴張后修復(fù)面頸部缺損24例。 結(jié)果:(1)上臂內(nèi)側(cè)自深筋膜淺層發(fā)出的皮動脈8～9支,各皮動脈發(fā)出分支沿縱行方向相互吻合。上臂皮瓣的中間部位即內(nèi)側(cè)肌間隔間隙吻合支最為豐富,其次為臂內(nèi)側(cè)皮瓣的臂后側(cè)部分。每側(cè)肢體均有2～5支明顯的貫串上臂全長的吻合支,多位于皮瓣的中部及后部。皮動脈穿出點集中臂內(nèi)側(cè)肌間隔區(qū)域,最遠一支距肘橫紋3.47±1.50cm,近端分支距腋窩橫皺襞距離約1.64±1.22cm。(2)24例應(yīng)用上臂內(nèi)側(cè)擴張皮瓣修復(fù)面頸部缺損的病例中,上臂擴張皮瓣面積最大20cm×15cm,最小4cm×5.5cm,其中以近端為蒂者12例,遠端者15例,以遠端為蒂者2例患者遠端出現(xiàn)部分壞死,其余皮瓣全部成活隨訪3個月～2年,效果滿意。 結(jié)論:(1)上臂內(nèi)側(cè)皮瓣血供介于軸型皮瓣與任意型皮瓣之間,切取時長寬比例超過任意型皮瓣。皮瓣為雙向供血,無論以近端為蒂還是遠端為蒂切取皮瓣是安全的。以內(nèi)側(cè)肌間隔為軸線,沿深筋膜淺層設(shè)計順行或逆行皮瓣血供可靠,切取皮瓣安全,如需擴大切取皮瓣,向后擴展延伸較向前擴展可靠。皮瓣制作時皮瓣蒂部盡可能置于肌間隔,蒂寬約4cm。以近端為蒂時,擴張器剝離腔隙近端不超過距腋窩橫皺襞3cm,遠端為蒂時,擴張器剝離腔隙遠端不超過距肘橫紋5cm。(2)上臂擴張皮瓣色澤、質(zhì)地佳,經(jīng)過擴張后,切取皮瓣面積較大,供區(qū)多可直接縫合,是面頸部瘢痕修復(fù)的良好供區(qū)。
[Abstract]:Objective: the purpose of this study was to provide theoretical guidance for the clinical application of medial upper arm expanded flap through the study of vascular microanatomy above the superficial layer of deep fascia of medial upper arm flap, and to apply pedicle transfer of medial upper arm flap to repair face and neck defect. Methods: 10 sides of fresh adult upper limbs were perfused with latex. Four times magnifying glass was dissected from the superficial to the depth to observe the anastomosis of the vessels in the superficial fascia and the number of anastomotic branches and the position of the cutaneous artery perforating the deep fascia. The clinical application of the flap to repair 24 cases of face and neck defect was summarized. Results: (1) the medial upper arm gave off 89 cutaneous arteries from the superficial layer of deep fascia, and the branches of each cutaneous artery were anastomosed with each other along the longitudinal direction. The middle part of the upper arm flap, the anastomotic branch of the medial septal space, was the most abundant, followed by the posterior arm part of the medial arm flap. In each limb, there were 2 or 5 obvious anastomotic branches of the upper arm, most of which were located in the middle and posterior part of the flap. The distance from the medial arm muscle septum to the elbow transverse stria was 3.47 鹵1.50 cm, and the distance from the proximal branch to the axillary transverse fold was about 1.64 鹵1.22 cm. (2) in 24 cases, the medial upper arm expanded flap was used to repair the face and neck defect, and the distance between the proximal branch and the axillary transverse fold was 1.64 鹵1.22 cm. The area of the expanded upper arm flap was the largest 20cm 脳 15 cm, and the smallest 4cm 脳 5.5 cm, of which 12 cases were proximal pedicle, 15 distal and 2 distal pedicled. The remaining flaps survived for 3 months to 2 years, and the results were satisfactory. Conclusion: (1) the blood supply of medial upper arm flap is between the axial flap and the arbitrary flap. The flap is a two-way blood supply. It is safe to cut the flap with proximal or distal pedicle. With the medial septum as the axis, the blood supply of the anterograde or retrograde flap was designed along the superficial layer of deep fascia, and it was safe to cut the flap. If it is necessary to extend the flap, the posterior extension is more reliable than the forward expansion. When the flap was made, the pedicle was placed as far as possible in the muscular septum, and the pedicle width was about 4 cm. When the proximal pedicle was used as pedicle, the proximal end of the space was not more than 3 cm from the lateral fold of the armpit, and the distal end of the distally pedicle was not more than 5 cm. (2) the color and texture of the expanded upper arm flap was good, and after expansion, the distensibility of the distally distended space was not more than 5 cm from the transverse stripe of the elbow. The flap has a large area, and the donor area can be sutured directly. It is a good donor area for scar repair in the face and neck.
【學(xué)位授予單位】：中國協(xié)和醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2008
【分類號】：R622;R322
本文編號：2358443
[Abstract]:Objective: the purpose of this study was to provide theoretical guidance for the clinical application of medial upper arm expanded flap through the study of vascular microanatomy above the superficial layer of deep fascia of medial upper arm flap, and to apply pedicle transfer of medial upper arm flap to repair face and neck defect. Methods: 10 sides of fresh adult upper limbs were perfused with latex. Four times magnifying glass was dissected from the superficial to the depth to observe the anastomosis of the vessels in the superficial fascia and the number of anastomotic branches and the position of the cutaneous artery perforating the deep fascia. The clinical application of the flap to repair 24 cases of face and neck defect was summarized. Results: (1) the medial upper arm gave off 89 cutaneous arteries from the superficial layer of deep fascia, and the branches of each cutaneous artery were anastomosed with each other along the longitudinal direction. The middle part of the upper arm flap, the anastomotic branch of the medial septal space, was the most abundant, followed by the posterior arm part of the medial arm flap. In each limb, there were 2 or 5 obvious anastomotic branches of the upper arm, most of which were located in the middle and posterior part of the flap. The distance from the medial arm muscle septum to the elbow transverse stria was 3.47 鹵1.50 cm, and the distance from the proximal branch to the axillary transverse fold was about 1.64 鹵1.22 cm. (2) in 24 cases, the medial upper arm expanded flap was used to repair the face and neck defect, and the distance between the proximal branch and the axillary transverse fold was 1.64 鹵1.22 cm. The area of the expanded upper arm flap was the largest 20cm 脳 15 cm, and the smallest 4cm 脳 5.5 cm, of which 12 cases were proximal pedicle, 15 distal and 2 distal pedicled. The remaining flaps survived for 3 months to 2 years, and the results were satisfactory. Conclusion: (1) the blood supply of medial upper arm flap is between the axial flap and the arbitrary flap. The flap is a two-way blood supply. It is safe to cut the flap with proximal or distal pedicle. With the medial septum as the axis, the blood supply of the anterograde or retrograde flap was designed along the superficial layer of deep fascia, and it was safe to cut the flap. If it is necessary to extend the flap, the posterior extension is more reliable than the forward expansion. When the flap was made, the pedicle was placed as far as possible in the muscular septum, and the pedicle width was about 4 cm. When the proximal pedicle was used as pedicle, the proximal end of the space was not more than 3 cm from the lateral fold of the armpit, and the distal end of the distally pedicle was not more than 5 cm. (2) the color and texture of the expanded upper arm flap was good, and after expansion, the distensibility of the distally distended space was not more than 5 cm from the transverse stripe of the elbow. The flap has a large area, and the donor area can be sutured directly. It is a good donor area for scar repair in the face and neck.
【學(xué)位授予單位】：中國協(xié)和醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2008
【分類號】：R622;R322
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本文編號：2358443
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