發(fā)布時(shí)間：2018-11-26 11:31

【摘要】： 目的:本研究旨在通過(guò)對(duì)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(kuò)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(biāo)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(jìn)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(dòng)脈穿出深筋膜的位置。并總結(jié)臨床應(yīng)用該皮瓣擴(kuò)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(dòng)脈8～9支,各皮動(dòng)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(zhǎng)的吻合支,多位于皮瓣的中部及后部。皮動(dòng)脈穿出點(diǎn)集中臂內(nèi)側(cè)肌間隔區(qū)域,最遠(yuǎn)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(kuò)張皮瓣修復(fù)面頸部缺損的病例中,上臂擴(kuò)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(yuǎn)端者15例,以遠(yuǎn)端為蒂者2例患者遠(yuǎn)端出現(xiàn)部分壞死,其余皮瓣全部成活隨訪3個(gè)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(shí)長(zhǎng)寬比例超過(guò)任意型皮瓣。皮瓣為雙向供血,無(wú)論以近端為蒂還是遠(yuǎn)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(jì)順行或逆行皮瓣血供可靠,切取皮瓣安全,如需擴(kuò)大切取皮瓣,向后擴(kuò)展延伸較向前擴(kuò)展可靠。皮瓣制作時(shí)皮瓣蒂部盡可能置于肌間隔,蒂寬約4cm。以近端為蒂時(shí),擴(kuò)張器剝離腔隙近端不超過(guò)距腋窩橫皺襞3cm,遠(yuǎn)端為蒂時(shí),擴(kuò)張器剝離腔隙遠(yuǎn)端不超過(guò)距肘橫紋5cm。(2)上臂擴(kuò)張皮瓣色澤、質(zhì)地佳,經(jīng)過(guò)擴(kuò)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(guó)協(xié)和醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R622;R322

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 姜樹學(xué);李吉;;臂內(nèi)側(cè)皮瓣的顯微外科解剖學(xué)[J];解剖學(xué)報(bào);1983年03期

2 葛茂星,梁明,陳宗華,朱亞波;臂內(nèi)側(cè)筋膜皮瓣修復(fù)肘部深度電燒傷創(chuàng)面1例報(bào)告[J];昆明醫(yī)學(xué)院學(xué)報(bào);2005年03期

3 楊增年,施浩然,曹亮,王寶春,吳晉寶,王永珍,朱鈺;上臂內(nèi)側(cè)皮瓣游離移植解剖研究和臨床應(yīng)用[J];上海第二醫(yī)學(xué)院學(xué)報(bào);1983年04期

4 高學(xué)書;何清濂;章惠蘭;劉琪;袁相斌;高健華;毛增榮;施思娟;;上臂內(nèi)側(cè)皮瓣游離移植一例報(bào)道[J];上海醫(yī)學(xué);1984年11期

5 王和平,楊曉東;上臂內(nèi)側(cè)皮瓣修復(fù)鼻缺損16例[J];實(shí)用美容整形外科雜志;2000年04期

6 于麗;王佳琦;王yN蓉;丁俊生;;擴(kuò)張后的上臂內(nèi)側(cè)逆行皮瓣在面部瘢痕攣縮合并鼻缺損修復(fù)中的應(yīng)用[J];中國(guó)美容整形外科雜志;2007年05期

7 孟慶延,李吉;上臂內(nèi)外側(cè)軸型皮瓣間血供的顯微外科解剖學(xué)[J];中國(guó)醫(yī)科大學(xué)學(xué)報(bào);1989年06期

8 陳伯華,司徒樸,熊明根,肖能坎,顧浩,侯瑞興,張余光;上臂內(nèi)側(cè)真皮下血管網(wǎng)薄皮瓣鼻再造[J];中華醫(yī)學(xué)美容雜志;1996年02期

9 顧黎明，吳建林，，沈建祖，祝偉，徐雷，壽奎水;吻合血管的上臂內(nèi)側(cè)皮瓣在手外科的應(yīng)用[J];中華手外科雜志;1994年02期

10 周祥吉，范啟申;臂內(nèi)側(cè)皮瓣修復(fù)虎口軟組織重度缺損10例[J];中華手外科雜志;1995年04期

本文編號(hào)：2358443