保留胸背神经的背阔肌皮瓣的解剖与临床应用  

Anatomy and application study of the latissimus dorsi flap without excising thoracodorsal nerve

作　　者：杨涌[1] 曹东升[1] 黄学应[2] 盛辉[3] 丁浩[1] 汪春兰[1] 

机构地区：[1]安徽医科大学第一附属医院整形外科,合肥230022 [2]安徽医科大学人体解剖学教研室,合肥230032 [3]江苏省泰兴市人民医院整形外科,泰兴225400

出　　处：《安徽医科大学学报》2008年第1期102-104,共3页Acta Universitatis Medicinalis Anhui

基　　金：安徽省临床医学重点学科应用技术项目(编号:05A012)

摘　　要：目的探索切取背阔肌皮瓣最大程度保留肌肉功能的方法和效果。方法①选用16具32侧成人躯干标本,对胸背神经、血管进行显微解剖观测。②在解剖研究基础上,应用保留胸背神经的背阔肌皮瓣移植修复肢体和头面部大块软组织缺损共4例。结果①从胸背神经一级分支分叉处向近心端至见到内侧支和外侧支之间有神经纤维交织处长度为(25.12±3.19)mm。胸背动脉起始部外径为(2.32±0.15)mm,总干长为(56.75±4.99)mm。胸背神经起始部干径为(2.14±0.29)mm,总干长为(61.22±8.51)mm。胸背神经与胸背动脉之间的最宽距离是(2.98±0.08)mm。②3例移位皮瓣、1例吻合移植,术后皮瓣完全成活。保留背阔肌的外形良好,肩关节内收、内旋、后伸功能与术前无明显差异。结论应用保留胸背神经的部分背阔肌皮瓣移植,可根据缺损情况随机切取肌肉量,最大限度地保留了背阔肌的功能,是躯体大块组织缺损较理想的修复方法。Objective To explore the method and result of remaining the preserved latissimus dorsal muscle function when latissimus dorsi flap is excised. Methods （1） Sixteen human cadavers（32 sides） were selected. Through microdissection thoracodorsal nerve and thoracodorsal artery blood vessel was observered. （2） The latissimus dorsi flaps without excising thoracodorsal nerve were used in 4 cases based on the anatomical study. Results （1） The distance between the crotch of thoracodorsal nerve first class branches and that of nerve fiber was（25.12 ± 3.19 ） mm. The diameter of initiation part and distance of thoracodorsal artery is （2. 32 ±0. 15 ）mm and （56. 75 ±4. 99 ） mm. The diameter of initiation part and distance of thoracodorsal nerve is （2. 14 ±0. 29）mm and （61.22 ±8.51 ） mm. The longissimus distance between thoracodorsal nerve and thoracodorsal artery is （2. 98 ± 0. 08 ）mm. （2） Three cases displacement flaps and one case anastomosis flap were survival completely, and the appearance of the reserved muscles were fine, and the function of the articulatio humeri was not different compared with pro-operation such as endoductionn, adtorsion. Conclusion As harvesting latissimus dorsi flap without excision thoracodrsal nerve muscle can be excised ranly according to defect. The function loss of latissimus dorsi muscle can be reduced, when this method is used, and it is a good method for repairing a large area defect.

关 键 词：外科皮瓣 背/解剖学与组织学 

分 类 号：R622[医药卫生—整形外科] R622.1[医药卫生—外科学]