MDCTA辅助设计的腓肠内侧动脉穿支皮瓣修复手腕部皮肤软组织缺损  

Reconstruction of the hand and wrist defect with the medial sural artery perforator flap designed with the help of nnflti-detector computer tomography angiography

作　　者：范学锴 潘佳栋 夏华杰 王欣 陈川 陈宏 章伟文 

机构地区：[1]宁波第六医院手外科,浙江315040

出　　处：《中华手外科杂志》2015年第5期365-368,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨多排螺旋CI＇血管造影（multi—detectorcomputertomographyang40graphy，MDCTA）辅助设计腓肠内侧动脉穿支皮瓣（medialsuralarteryperforatorn叩，MSAP）的方法及应用该皮瓣修复手腕部皮肤软组织缺损的手术技巧和临床疗效。方法2013年4月至2014年10月，我们对13例手腕部皮肤软组织缺损的患者，术前进行MASP供区的MDCTA扫描和血管三维重建。皮瓣均依据CT显示的腓肠内侧动脉（medialsuralartery，MSA）穿支及其源血管的走行和分布特点进行设计，面积为6．5cm×4．5cm～12．0cm×8．0cm，皮瓣血管蒂动脉采用端端吻合，其中与受区桡动脉深支吻合9例，与掌背动脉吻合4例。结果共获13例26侧小腿的MDCTA数据，所有肢体的MSA均可显影，其中单支型8侧，双支型15侧，三支型（多支型）3侧。CT中显影的MSA穿支数共56个，穿支入皮点距胭窝水平线（6．4±2．5）cm，血管蒂（MSA与穿支长度之和）最长可达10．0cm。穿支血管术前定位和术中解剖位置基本符合，1例因皮肤横向位移导致1．0cm误差。术后13例皮瓣均顺利存活，随访时间为6～12个月，皮瓣外观无臃肿，色泽和受区相似。供区瘢痕位置隐蔽，行走功能无明显影响。结论对拟行MSAP的患者术前进行双侧小腿的MDCTA检查，能设计出个体化的MSAP，降低手术时间和风险，提高皮瓣成活率。Objective To investigate the role of multi-detector computer tomography angiography （MDCTA） in flap design of the medial sural artery perforator flap （MSAP） and the surgical techniques and treatment outcomes of MSAP flap for repairing soft tissue defects of the hand and wrist. Methods From April 2013 to October 2014, 13 patients with soft tissue defects of the hand and wrist were treated with MSAP flap transfer. Preoperatively MDCTA of the flap donor site was acquired and 3D reconstruction of vessels was done. The flap was then designed based on the location, course and distribution of the medial sural artery perforators. The flap size ranged from 6.5 cmx 4.5 cm to 12.0 crux 8.0 cm. The artery of the flap pedicle was anastomosed with the deep branch of the radial artery in 9 patients and with the metacarpal dorsal artery in 4 patients in an end-to-end fashion. Results MDCTA images of 26 lower extremities in 13 patients were acquired preoperatively. The medial sural artery and their branches could be visualized clearly in all the cases. The single branch type of MSA was seen in 8 lower extremities, the double branch type in 15 lower extremities, and the triple branch type in 3 extremities. Cumulatively there were 56 perforators shown by MDCTA. The distance from the perforator location to the horizontal line of the popliteal fossa was （6. 4 ± 2.5） cm. The maximal pedicle length including MSA and its perforator was 10.0 cm. The preoperative perforator locations marked with MDCTA coincided with surgical dissection findings in all but one case in which perforator location was 1.0 cm off due to transverse shift of the skin. All the flaps survived uneventfully. The patients were follow-up for 6 to 12 months. The flaps were not bulky. Flap color was close to that of the recipient site. Scar at the donor site was concealed. There was no impairment in motor flmction of the lower extremity in our series. Conclusion Preoperative MDCTA can help custom design MSAP flap for patients. It also helps to shorten the su

关 键 词：外科皮瓣 血管造影术 腓肠内侧动脉 穿支 

分 类 号：R622.1[医药卫生—整形外科]