改良胸背动脉穿支皮瓣的临床应用  

Clinical application of the modified thoracodorsal artery perforator flap

作　　者：尹玉凤[1] 熊竹友[1] 李光早[1] 张莉[1] 徐静[1] 高嵩[1] 

机构地区：[1]安徽省蚌埠市第三人民医院整形烧伤科,233004

出　　处：《蚌埠医学院学报》2017年第4期437-440,共4页Journal of Bengbu Medical College

基　　金：安徽省卫生厅医学科研项目(2010B022)

摘　　要：目的:探讨血管蒂周围携带部分肌肉的改良胸背动脉穿支皮瓣的临床应用。方法:临床应用改良胸背动脉穿支皮瓣11例,术前皮瓣设计时应用多普勒血流仪探测胸背动脉外侧支主要穿支血管在体表的分布并定位,术中分离穿支血管时周围携带宽3~5 cm肌肉,供区保留大部分背阔肌及胸背神经,即改良胸背动脉穿支皮瓣。植皮或拉拢缝合修复供区,其中同侧血管蒂邻近转移4例,游离移植7例。结果:11例中仅1例游离出现血管危象后坏死,余10例全部成活。皮瓣最大面积为22 cm×15 cm,最小为8 cm×5 cm。随访6~24个月,皮瓣血运良好,质地柔软,除足部切面修复者稍显臃肿外,余者外形满意。供区隐蔽,有明显瘢痕但无背阔肌功能障碍。结论:通过多普勒血流仪可指导术前胸背动脉穿支血管定位,胸背动脉的穿支血管解剖位置较为恒定,穿支周围携带部分肌肉蒂的改良皮瓣切取较方便,成活率高。Objective：To investigate the clinical application of the modified thoracodorsal artery perforator flap with partial muscle around vascular pedicle.Methods：Eleven cases treated with modified thoracodorsal artery perforator flaps were applied.The distribution and location of the main perforator vessels of thoracodorsal artery lateral branches were explored using Doppler flowmetry before operation.The perforator vessels with 3 to 5cm muscle in width were separated,and the modified flap with most partial latissimus dorsi muscle and thoracodorsal nerve was designed.The donor area was repaired with skin-grafting or direct suturing.The near transferring of ipsilateral vascular pedicle in 4 cases and free grafting in 11 cases were applied.Results：One case necrosed after vascular crisis,and other 10 cases survived.The largest and smallest area of the flaps were 22 cm＆#215;15 cm and 8 cm＆#215;5 cm,respectively.During the following up of 6 to 24 months,the blood supply and texture of flaps were fine.Except the repairing of the foot wound was slightly overstaffed,other appearances were good.The donor site was hidden,and has obvious scars.The dysfunction of latissimus dorsi was not found.Conclusions：The perforator vessel of thoracodorsal artery can be located by Doppler flowmetry before operation.The anatomical position of the perforator vessel of thoracodorsal artery is relatively constant,the cutting of modified flap with partial muscle around perforator is convenient,and the survival rate of which is high.

关 键 词：穿支皮瓣 胸背动脉 多普勒血流仪 

分 类 号：R622.1[医药卫生—整形外科]