T形血管吻合的游离胸背动脉穿支皮瓣的临床应用  

Clinical application thoracodorsal artery perforator flap with T-configuration vascular anastomosis

作　　者：李涛[1] 陈振兵[1] 翁雨雄[1] 丛晓斌[1] 艾方兴[1] 周攀[1] 洪光祥[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院手外科,武汉430022

出　　处：《中华手外科杂志》2015年第1期56-60,共5页Chinese Journal of Hand Surgery

基　　金：湖北省自然科学基金资助项目（2013CFC040）

摘　　要：目的 探讨“T”形血管吻合的游离胸背动脉穿支皮瓣移植的方法以及修复四肢创面缺损的临床效果.方法 2011年9月至2013年2月,对11例四肢缺损创面患者,男7例,女4例,年龄27- 62岁,采用“T”形血管吻合的游离胸背动脉穿支皮瓣修复,将胸背动脉主干、内侧支分别与受区动脉近、远断端行端-端吻合;胸背动脉伴行静脉（8例为2支,3例为1支）与受区浅静脉（或伴行静脉）行端-端吻合;2-3支皮神经共干与受区皮神经行端-端缝合.术后问卷调查患者对皮瓣外形的满意度（％）,检测皮瓣痛触觉、温度觉、两点分辨觉（mm）,对患肢功能行Enneking评分.结果 11例皮瓣均存活良好,皮瓣外形美观、质地耐磨,“T”形血管血流通畅.9例术后随访12- 24个月,供区切口均Ⅰ期愈合,患者对皮瓣外形满意（100％）.术后12个月皮瓣感觉神经功能评级为7例S3＋、2例S3;Enneking评分为21 - 28分,达到正常侧的72％ - 93％,平均值为85.3％.结论 “T”形血管吻合的游离胸背动脉穿支皮瓣移植是修复四肢创面缺损的一种较好的术式,尤其适用于四肢缺血、慢性溃疡、合并主干血管损伤的创面修复,并可根据创面情况改进为多种切取方式.Objective To investigate the technique of free transplantation of thoracodorsal artery perforator flap with T-configuration vascular anastomosis and evaluate the clinical outcomes of using this flap for repairing defects of the extremities.Methods From September 2011 to February 2013,a total of 11 cases with soft tissue defects of the extremities were treated with thoracodorsal artery perforator flap transfer.There were 7 male patients and 4 female patients whose age ranged from 27 to 62 years.The T-configuration vascular anastomosis was formed by anastomosing the thoracodorsal artery and its medial branch to the proximal and distal ends of the recipient site artery respectively in an end-to-end fashion.The thoracodorsal vein （2 branches in 8 cases and 1 in 3 cases） was sutured to the superficial vein at the recipient site or to the venae comitantes of the recipient artery in an end-to-end manner.Two or three branches of flap cutaneous nerves were coapted with cutaneous nerves of the recipient site.Postoperative evaluations included questionnaire of flap aesthetic satisfaction,touch,pain and temperature perceptions,two-point discrimination,and Enneking score of limb functions.Results All 11 flaps survived completely.All the wounds at the donor sites achieved primary healing.The flaps had good appearance and were durable.The T-configuration vascular anastomosis was patent ensuring good perfusion of the recipient limb.Nine cases had more than 12 to 24 months＇postoperative follow-up.100% of the patients were satisfied with flap aesthetics.Sensation of the flaps was graded as S3＋ in 7 cases and S3 in 2 cases at 12 months postoperatively.The Enneking score was 21 to 28,reaching 72% to 93% （average 85.3%） of the normal side.Conclusion Thoracodorsal artery perforator flap transfer with T-configuration vascular anastomosis is a good option for repairing defects of the extremities.The flow-through manner provides perfusion to both the flap and the recipient extremity,therefore this flap is ideal for wound cove

关 键 词：动脉 软组织损伤 穿支 血流桥接皮瓣 缺损 

分 类 号：R622.1[医药卫生—整形外科]