MSCTA辅助穿支皮瓣移植的初步报告  

Perforator flap transplantation assisted by the multislice spiral computed tomographic angiography:the clinical report

作　　者：高建明[1] 薛峰 夏云宝 储旭东[1] 华国军[1] 李坤[1] 骆宇春[1] 潘功茂 

机构地区：[1]解放军第101医院骨科 [2]放射科,江苏无锡214044

出　　处：《中国临床解剖学杂志》2011年第6期637-640,共4页Chinese Journal of Clinical Anatomy

基　　金：南京军区医药卫生科研基金项目(07M015)

摘　　要：目的探讨MSCTA在穿支皮瓣移植中应用的可行性。方法自2009年5月~2010年9月,我们对6例小腿、足踝软组织缺损病人拟行穿支皮瓣移植修复术,术前行MSCTA检查,下肢血管三维成像,术中根据穿支皮瓣的穿支血管的位置、直径、分布情况,设计穿支皮瓣的血管蒂,皮瓣轴心线,以及皮瓣的大小,行穿支皮瓣移植手术。结果 MSCTA图像显示：2例膝上外侧动脉穿支、4例胫后动脉穿支图像清晰,而且与皮瓣移植手术中解剖穿支血管情况完全一致。2例穿支皮瓣行吻合血管游离移植,4例穿支皮瓣带蒂转移,手术顺利完成。5例皮瓣完全成活,1例皮瓣边缘坏死,1个月后皮瓣整形后愈合良好。结论 MSCTA图像在穿支皮瓣移植手术中提供有价值的解剖路径,对穿支血管显影有良好的敏感性,缩短了手术时间,明显提高手术的准确性。因此,MSCTA在穿支皮瓣移植中的应用具有良好的可行性。Objective To investigate the potentiality of multislice spiral computed tomographic angiography（MSCTA） on preoperative planning of the perforator flap transplantation.Methods From May 2009 to September 2010,6 cases with soft tissue defects of lower extremity,ankle and foot were treated in our department using perforator flaps.MSCTA was performed preoperatively in all patients scheduled for tissue transfer.MSCTA showed three dimensional images of blood vessels of the lower extremities and perforators.During perforator surgery,MSCTA image assessment allowed us to plan the axis,size and shape of perforator flaps according to the position,calibre and course of pedicled vessels.Results MSCTA images showed perforator vessels clearly,including lateral superior genicular artery perforating rami and posterior tibial artery perforating rami in 2 and 4 cases respectively,which was consistant to the course of perforator vessels observed during the operation.2 cases were treated with the vascularized iliotibial flap transplantation,and 4 cases with the pedicled flaps transfer.Perforator flaps survived well in 5 cases,partly necrosis appeared in only 1 case.After one month,plastic flap recovered well.Conclusions MSCTA is valuable for providing anatomic reference during perforator flap transplantation.

关 键 词：多层螺旋CT血管成像 穿支皮瓣 膝上外侧动脉 外科皮瓣 

分 类 号：R323.72[医药卫生—人体解剖和组织胚胎学] R616.2[医药卫生—基础医学]