腓动脉穿支皮瓣的血流动力学变化及其临床意义  

Hemodynamic changes of peroneal perforator flaps and their clinical significance

作　　者：陈雪松[1] 徐永清[2] 陈建明[1] 马志显[3] 吉丽[1] 管力[1] 张黎明[1] 余晓军[1] 何金顺[1] 李小松[1] 

机构地区：[1]解放军第五十九医院创伤显微外科,成都军区战创伤显微外科中心,开远661600 [2]成都军区昆明总医院全军创伤骨科研究所 [3]解放军第五十九医院彩超室,开远661600

出　　处：《中华创伤杂志》2014年第11期1093-1096,共4页Chinese Journal of Trauma

摘　　要：目的 研究腓动脉皮穿支血流速度在形成穿支皮瓣前、后的变化规律及其临床意义.方法 应用彩色多普勒血流成像（color doppler flow imaging,CDFI）技术测定38个腓动脉穿支皮瓣的供血皮穿支术前、术后收缩期峰值流速（peak systolic flow velocity,PSFV）.从血流动力学角度探讨影响率与供血及皮瓣成活能力的相关因素,结合临床总结相应的皮瓣设计及手术要点.结果 皮瓣均全部成活,其供血皮穿支PSFV术前为（24.68± 15.15） cm/s,术后为（38.65±16.96） cm/s.其中游离移植共12个,术前、术后PSFV分别为（14.19±6.28） cm/s及（32.69±15.86） cm/s.带蒂移植共26个,术前PSFV为（29.52± 15.65） cm/s,术后为（41.40± 17.04.86） cm/s（P均＜0.01）,提示术后流速较术前显著增加.结论 （1）将血管蒂游离至根部并结扎所有无关分支有助于获得最大的皮穿支血流压及流速,增加皮瓣供血量;（2）从血流动力学角度解释了该皮瓣穿支经低阻力供血渠道远距离跨区供血现象（例如轴线上存在皮神经营养血管链）.Objective To determine the blood flow velocity of peroneal artery perforator flaps and the related clinical significance.Methods Peak systolic flow velocity （PSFV） of 38 peroneal artery perforator flaps were measured with color doppler flow imaging （CDFI） before and after flap surgery.Flap design and surgical points were summarized in combination with correlation factors affecting vascular supply and survival of perforator flaps and clinical data.Results All flaps survived.PSFV of the supplying skin perforators was （24.68± 15.15） cm/s preoperatively and （38.65± 16.96） cm/s postoperatively.There were 12 free perforator flaps with significant increase in PSFV after operation in comparison with that before operation [（32.69± 15.86） cm/s vs （14.19±6.28） cm/s,P〈0.01].Pedicled perforator flaps amounted to 26 and PSFV significantly increased from preoperative （29.52± 15.65）cm/s to postoperative （41.40± 17.04）cm/s （P〈0.01）.Conclusion The vessel pedicles should be dissected thoroughly and all irrelevant branches arising from them should be ligated to gain maximal flow through the perforator.The phenomenon of crossing angiosomes of the flap＇ s blood supply especially through the long and low-resistant neurocutaneous vascular axis can be explained from a hemodynamic view.

关 键 词：软组织损伤 血流动力学 穿支皮瓣 

分 类 号：R622[医药卫生—整形外科]