本文選題：股前外側(cè)皮瓣 + 小腿��； 參考：《華北理工大學(xué)》2017年碩士論文

【摘要】：目的探討股前外側(cè)游離皮瓣修復(fù)小腿皮膚軟組織缺損的臨床療效;對股前外側(cè)皮瓣的穿支血管進行臨床觀測,并將來源于降支和外側(cè)支的穿支血管進行對比分析;為精準切取分葉皮瓣、嵌合皮瓣奠定臨床基礎(chǔ),以更好的指導(dǎo)臨床應(yīng)用。方法收集2010年9月至2016年9月期間華北理工大學(xué)附屬骨科醫(yī)院小腿皮膚軟組織缺損行股前外側(cè)游離皮瓣修復(fù)治療的病例資料32例,男25例,女7例。年齡最小15歲,最大58歲。創(chuàng)面面積5.0cm×12.0cm~12.0cm×22.0cm,皮瓣切取面積7.0cm×15.0cm~13.0cm×25.0cm。受傷至手術(shù)時間為12~45天。研究方法:術(shù)前用創(chuàng)新的肌間隙血管穿支定位方法,輔以多普勒血流探測儀預(yù)先探測動脈搏動點并做好標記,依標記的穿支血管部位及創(chuàng)面缺損面積、深度等大小設(shè)計皮瓣,將探測的血管穿支總體設(shè)計在皮瓣的中上1/3部的軸線上。術(shù)中切開皮瓣探尋穿支并沿血管束進行逆行解剖,顯露整個皮瓣血管蒂的情況,觀測、記錄術(shù)中有效穿支與術(shù)前探測穿支位置是否一致,穿支與A點位置關(guān)系、穿支淺出點外徑、穿支起始處外徑、穿支類型、肌皮穿支穿肌長度及穿支血管的來源動脈等數(shù)據(jù)。結(jié)果本組行股前外側(cè)游離皮瓣修復(fù)的32例皮瓣中,31例完全成活(其中發(fā)生血管危象1例);1例遠端部分壞死,經(jīng)皮片移植術(shù)后創(chuàng)面愈合。隨訪5~24月,平均8個月,傷口無再破潰,皮瓣的皮膚顏色較周圍正常皮膚無明顯差異,皮瓣質(zhì)地柔軟,外形滿意,均有不同程度保護性感覺恢復(fù)。皮瓣供區(qū)未見嚴重瘢痕,無明顯感覺異常,無股四頭肌功能障礙。術(shù)中共發(fā)現(xiàn)穿支血管68支,其中50支用于皮瓣的切取,其中40支(80%)來自降支,10支(20%)來自外側(cè)支(高位皮動脈),探測其切取皮瓣的有效動脈穿支符合率為98%。我們統(tǒng)計并發(fā)現(xiàn)50支穿支與A點的位置關(guān)系分布如下:外側(cè)支的穿支血管的70%位于A點以近,其余30%位于A點以遠;降支穿支血管的65%位于A點以遠,12.5%位于A點,22.5%位于A點以近;但所有穿支均位于均位于股直肌與股外側(cè)肌肌間隙及其外側(cè)。旋股外側(cè)動脈降支(或外側(cè)支)起始處至穿支起始處長度9.6cm±3.50cm(6.0cm~15.0cm);穿支肌內(nèi)走行長度為:8.14cm±0.12cm(5.0cm~10.5cm);出肌點至入皮點(穿支肌外走行)長度:1.95cm±0.09cm(1.0cm~5.5cm);旋股外側(cè)動脈降支(或外側(cè)支)起始處的外徑為2.7mm±0.6mm(2.2mm~3.7mm);穿支起始處外徑為1.8mm±0.9mm(1.3mm~2.8mm);穿支淺出點處外徑為0.6mm±0.1mm(0.4mm~1.2mm)。結(jié)論股前外側(cè)皮瓣術(shù)是修復(fù)小腿皮膚軟組織缺損的可靠方法,具有滿意的臨床療效;創(chuàng)新的肌間隙定位法輔以多普勒探測技術(shù)能夠提高術(shù)前穿支血管定位的準確率;有效穿支均位于股直肌與股外側(cè)肌肌間隙及其外側(cè)。
[Abstract]:Objective to investigate the clinical effect of free anterolateral femoral flap on repairing skin and soft tissue defects of the leg, to observe the perforating vessels of the anterolateral femoral flap and to compare the perforating vessels from the descending and lateral branches. In order to accurately cut the lobulated flap and chimeric flap to lay a clinical foundation for better guidance of clinical application. Methods from September 2010 to September 2016, 32 cases (25 males and 7 females) with skin and soft tissue defects of the calf treated with anterolateral free thigh flap in affiliated Orthopaedics Hospital of North China University of Science and Technology were collected. The youngest is 15 and the oldest is 58. The wound area was 5.0cm 脳 12.0cm~12.0cm 脳 22.0cm, and the area of flap was 7.0cm 脳 15.0cm~13.0cm 脳 25.0cm. The time from injury to operation was 1245 days. Methods: preoperative localization of perforating branches of intermuscular space was performed with Doppler blood flow detector to detect the pulsatile point of the artery, and the flap was designed according to the area and depth of the defect of the perforating vessel and wound surface. The detected perforating branch is designed on the axis of the middle and upper third of the flap. The perforating branch was explored and dissected retrograde along the vascular bundle during the operation. The vascular pedicle of the whole flap was exposed. The position of the effective perforating branch was the same as the position of the perforating branch detected before operation, and the relationship between the perforating branch and the A point position was recorded. The external diameter of perforating branch, the origin of perforating branch, the type of perforating branch, the length of perforator muscle and the origin artery of perforating branch. Results among 32 cases of free femoral flap repaired, 31 cases survived completely (including 1 case with vascular crisis and 1 case with partial necrosis of distal end), and the wound healed after percutaneous grafting. Follow up for 5 ~ 24 months (mean 8 months) showed that there was no re-rupture of the wound, the skin color of the flap was not significantly different from that of the surrounding normal skin, the skin texture of the flap was soft, the appearance was satisfactory, and the skin flap had different degree of protective sensory recovery. There was no severe scar, no obvious sensory abnormality and no dysfunction of quadriceps femoris in the donor area of the flap. A total of 68 perforating vessels were found during the operation, of which 50 were used for the removal of the flap, of which 40 were from the descending branch (10 / 20) and 20 were from the lateral branch (superior cutaneous artery). The coincidence rate of detecting the effective perforating branch of the flap was 98. The relationship between 50 perforating branches and point A was found to be as follows: 70% of the perforating vessels of the lateral branch were located near point A and the other 30% were located in the distance from point A. 65% of descending branch perforators were located at point A, 12.5% at point A and 22.5% near point A, but all perforators were located in the space between rectus femoris and lateral muscle of femoris. The length of descending branch (or lateral branch) of lateral circumflex femoral artery (or lateral branch) is 9.6cm 鹵3.50 cm ~ 6.0 cm ~ (-1) ~ 15.0 cm ~ (-1); the length of intramuscular walk of perforating branch is 8.14 cm 鹵0.12 cm ~ 5.0 cm ~ (10.5 cm); the length of muscle exit point is 1.95 cm 鹵0.09 cm ~ (1.0) cm ~ (1.5 cm); the origin of descending branch of lateral femoral artery (or lateral branch) is 1.95 cm 鹵0.09 cm ~ (1.0) cm ~ (1.5 cm). The external diameters of the perforating branches were 2.7mm 鹵0.6mm / 2.2mm / 3.7mm, 1.8mm 鹵0.9mm / 1.3mm / 2.8mm and 0.6mm 鹵0.1mm / 0.4mm / 1.2mm / mm respectively. Conclusion the anterolateral femoral flap is a reliable method for repairing the skin and soft tissue defect of the lower leg and has a satisfactory clinical effect. The effective perforating branches were located in the space between the rectus femoris muscle and the lateral femoral muscle.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R658.3

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