發(fā)布時間：2018-03-04 02:19

  本文選題：螺旋槳皮瓣　切入點：穿支皮瓣　出處：《北京協(xié)和醫(yī)學院》2015年碩士論文　論文類型：學位論文

【摘要】：目的腹壁下動脈穿支皮瓣主要作為一個游離皮瓣,用于自體組織乳房再造；作為一個帶蒂皮瓣,主要以腹壁下動脈主干為蒂；廣泛的腹直肌剝離會造成嚴重的供瓣區(qū)損傷；本研究介紹單純以腹壁下動脈穿支為蒂的腹部螺旋槳皮瓣的臨床應用。方法自2010年3月至2014年12月,共有10位患者實施了以腹壁下動脈穿支為蒂的螺旋槳皮瓣,其中男、女各5例,年齡5-67歲,平均年齡22.8歲；病因?qū)W包括惡性腫瘤5例,燒傷后瘢痕攣縮5例。缺損的位置包括腹部(n=6)、腰腹部(n=3)和胸腹部(n=1)。所有皮瓣的穿支血管蒂放置于皮瓣的偏心位置,皮瓣旋轉(zhuǎn)一定角度后,皮瓣較大的部分用于修復缺損,而較小的部分用于協(xié)助供瓣區(qū)的關閉。結(jié)果缺損的大小8x5cm-30x9cm,平均大小為20.41x9.53cm;皮瓣大小為13x5cm-30×10cm,平均大小為22x8.47cm。血管蒂長度為2.5-5.5cm,平均4.15cm。6個皮瓣旋轉(zhuǎn)180度,4個皮瓣旋轉(zhuǎn)120度。其中橫向設計的皮瓣6個,斜向設計的皮瓣3個,垂直設計的皮瓣1個。手術后8個皮瓣全部成活；有2個旋轉(zhuǎn)1800的皮瓣出現(xiàn)了皮瓣尖端的部分壞死,所有皮瓣供瓣區(qū)均直接拉攏縫合,手術后沒有發(fā)現(xiàn)因為皮瓣的切取而導致的肌肉功能障礙或腹壁薄弱。結(jié)論以腹壁下動脈穿支為蒂的螺旋槳皮瓣無需切斷腹壁下動脈主干,僅在穿支血管于深筋膜上的發(fā)出點處對腹直肌進行小范圍的剝離。因此,與傳統(tǒng)的以腹壁下動脈主干為蒂的游離皮瓣或帶蒂皮瓣相比,降低了供瓣區(qū)損害；對于腹部、腰部的皮膚軟組織缺損,腹壁下動脈穿支蒂螺旋槳皮瓣是一種值得考慮的修復重建方法。
[Abstract]:Objective the perforating branch flap of inferior abdominal artery is mainly used as a free flap for reconstruction of autologous breast, as a pedicled flap with the main trunk of the inferior abdominal artery as the pedicle, and extensive rectus abdominis dissection will cause serious injury to the donor flap area. This study introduced the clinical application of propeller flap pedicled solely with the perforating branch of inferior abdominal artery. Methods from March 2010 to December 2014, 10 patients (male) were treated with propeller flap pedicled with perforating branch of inferior abdominal artery. The average age was 22.8 years, and the etiology included malignant tumor in 5 cases. Cicatricial contracture was found in 5 cases after burn. The location of the defect included abdominal nipple (6), waist and abdomen (3) and chest and abdomen (1). The perforating branches of all flaps were placed in the eccentric position of the flap. The larger part of the flap was used to repair the defect after the flap rotated at a certain angle. Results the defect size was 8x5cm-30x9cm, the average size was 20.41x9.53cm, the flap size was 13x5cm-30 脳 10cm, the average size was 22x8.47cm. The pedicle length was 2.5-5.5cm, the average 4.15cm.6 flaps rotated 180 degrees, 4 flaps rotated 120 degrees. Middle transverse design of 6 flaps, There were 3 oblique flaps and 1 vertical flaps. All the 8 flaps survived after operation. Two rotating-1800 flaps showed partial necrosis at the tip of the flaps, and all the flap donor areas were closed and sutured directly. No muscle dysfunction or weak abdominal wall was found after operation. Conclusion the propeller flap pedicled with the perforating branch of the inferior abdominal artery does not need to cut off the main trunk of the inferior abdominal artery. The rectus abdominis muscle is stripped only at the point at which the perforating vessel is issued on the deep fascia. Therefore, compared with the traditional free flap or pedicled flap pedicled with the main trunk of the inferior abdominal artery, the damage to the donor flap area is reduced; in the case of abdomen, The skin and soft tissue defect in the waist and the pedicled propeller flap pedicled with the perforating branch of the inferior abdominal artery are worthy of consideration.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R654.3

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本文編號：1563717