本文選題：隱神經 + 皮瓣　； 參考：《蘭州大學》2015年碩士論文

【摘要】：目的：總結應用隱神經營養(yǎng)血管遠端蒂島狀皮瓣轉移修復足踝部軟組織缺損修復中應用的臨床效果�？偨Y手術經驗,依據皮瓣血供的解剖特點,使隱神經營養(yǎng)血管遠端蒂島狀皮瓣切取轉移的手術方式逐步完善成熟,同時總結提高隱神經營養(yǎng)血管遠端蒂島狀皮瓣對足踝部軟組織缺損修復的功能療效。方法：對36例足踝部軟組織缺損應用隱神經營養(yǎng)血管遠端蒂島狀皮瓣轉移修復,詳細記錄本組所有患者病因,以及足踝部損傷導致的局部缺損的創(chuàng)面部位、創(chuàng)面的大小范圍和軟組織缺損創(chuàng)面的深度、皮瓣選擇及手術要求切取的范圍大小、手術時隱神經、大隱靜脈的外科處理方法、血管神經的吻合辦法,蒂部轉移手術處理技巧,以及術后患者恢復狀況的隨訪。分析可能導致皮瓣壞死的原因,術后受區(qū)皮膚感覺感覺、皮瓣受區(qū)功能情況和患者自覺是否美觀等相關因素。結合該皮瓣相關應用解剖和臨床醫(yī)學實踐研究的科研成果,探討隱神經營養(yǎng)血管遠端蒂島狀皮瓣修復足踝部軟組織缺損的手術方法及注意事項。結果：本組36例,男25例,女11例；年齡16-46歲,平均年齡28.5歲。均為創(chuàng)傷造成的足踝部軟組織缺損致骨外露。其中單純內踝區(qū)缺損者19例,足內側區(qū)缺損9例,足跟內側缺損4例,內外踝均缺損者4例。缺損面積為10.0×8.0cm～15.0×12.0cm。其中急診修復14例,延期修復22例。本組所有患者中有3例患者皮瓣存活欠佳,邊緣少量壞死,經過臨床反復多次清創(chuàng)換藥后創(chuàng)面愈合,其中1例術前局部存在嚴重感染的軟組織缺損創(chuàng)面患者手術后第6天,皮瓣局部受區(qū)發(fā)生感染,拆除皮瓣周圍部分縫線后充分引流感染灶,根據分泌物細菌實驗室培養(yǎng)及藥物敏感實驗,選用合適的抗生素,經過臨床反復多次清創(chuàng)換藥后創(chuàng)面愈合；其余病例皮瓣轉移均獲得成功,術后甲級愈合、功能良好。本組患者隨訪周期6月～36月。本組所有患者皮瓣術后血供良好,皮瓣轉移至受區(qū)后局部彈性佳,組織耐磨性強,患者自主感官滿意,皮瓣術后隨訪未出現潰瘍及局部皮膚嚴重瘢痕導致的攣縮,足踝部運動功能恢復滿意。結論：隱神經營養(yǎng)血管遠端蒂島狀皮瓣具有取材方便、解剖恒定、血供可靠、不犧牲主干血管、切取面積大,組織蒂長,旋轉幅度大、覆蓋能Ⅰ期完成等優(yōu)點,也存在皮瓣顯臃腫,術后局部瘢痕致外觀不滿意,犧牲一條感覺神經和大隱靜脈,導致供區(qū)感覺缺乏或靜脈回流障礙等不足,但總體來說,隱神經營養(yǎng)血管遠端蒂島狀皮瓣轉移修復足踝部軟組織缺損,手術操作不復雜、效果肯定。
[Abstract]:Objective: to summarize the clinical effect of repairing soft tissue defect of foot and ankle with island flap pedicled with saphenous neurotrophic vessels. According to the anatomical characteristics of the blood supply of the skin flap, the surgical method of the island flap pedicled with the distal pedicle of the saphenous nerve nutrient vessel was gradually perfected and matured. At the same time, the functional effect of saphenous neurotrophic vessel distally pedicled island flap in repairing soft tissue defect of foot and ankle was summarized. Methods: 36 cases of soft tissue defect of foot and ankle were repaired with saphenous neurotrophic vessel pedicled island flap. The etiology of all patients and the site of local defect caused by injury of foot and ankle were recorded in detail. The size of the wound and the depth of the soft tissue defect, the selection of the flap and the scope of the operation requirements, the surgical treatment of the saphenous nerve, the great saphenous vein, the anastomosis of the blood vessel and nerve, the technique of surgical treatment of pedicle transfer, the surgical treatment of the saphenous nerve during the operation. And follow-up of postoperative patients recovery. To analyze the possible causes of skin necrosis, the sensation of the skin, the function of the flap and the beauty of the patients. Combined with the scientific research results of applied anatomy and clinical practice of the flap, the surgical methods and precautions of repairing soft tissue defect of foot and ankle with island flap with distal pedicle of saphenous neurotrophic vessels were discussed. Results: there were 36 cases (25 males and 11 females) aged 16-46 years with an average age of 28.5 years. All of them were bone exposure caused by soft tissue defect of foot and ankle. There were 19 cases of medial ankle defect, 9 cases of medial defect of foot, 4 cases of medial defect of heel and 4 cases of defect of medial and lateral malleolus. The defect area was 10.0 脳 8.0cm~15.0 脳 12.0cm. There were 14 cases of emergency repair and 22 cases of delayed repair. Three of the patients had poor skin flap survival and marginal necrosis. The wound healed after repeated debridement and dressing change. One patient with severe local infection had severe soft tissue defect wounds 6 days after operation. Infection occurred in the local area of the flap, and the infected foci were fully drained after removing some sutures around the flap. According to the laboratory culture of secretion bacteria and the drug sensitive experiment, the appropriate antibiotics were selected, and the wound healed after repeated debridement and dressing change. The other cases of flap transfer were successful, grade A healing, good function. The follow-up period was 6 months to 36 months. All the patients had good blood supply after operation, good local elasticity after flap transfer to the recipient area, strong tissue wear resistance, satisfactory autonomic senses, and no postoperative contracture caused by ulcers and severe scar of local skin. The motor function of foot and ankle recovered satisfactorily. Conclusion: the island flap with distal pedicle of saphenous neurotrophic vessels has the advantages of convenient sampling, constant anatomy, reliable blood supply, no sacrificing of main vessels, large cut area, long tissue pedicle, large rotation amplitude, and the ability to cover the first stage. There are also defects such as bloated skin flap, dissatisfactory appearance caused by local scar after operation, sacrificing a sensory nerve and great saphenous vein, resulting in a lack of feeling in the donor area or obstruction of venous reflux, etc., but generally speaking, The soft tissue defect of foot and ankle was repaired with island flap pedicled with distal saphenous neurotrophic vessel. The operation was not complicated and the effect was positive.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R658.3

【共引文獻】

相關博士學位論文 前2條

1 江奕恒;股前外側區(qū)穿支血管三維重建與修薄皮瓣血供關系的研究[D];南方醫(yī)科大學;2007年

2 陳勝華;下肢血管的三維重建及相關組織瓣設計改進的解剖學研究[D];南方醫(yī)科大學;2009年

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本文編號：1852747