三维CT血管造影辅助下游离肩胛皮瓣修复肢体深度烧伤创面  

Effect of 3D-CTA assistant the post-burn limb reconstruction by free scapular flap

作　　者：马文国[1] 王成德[2] 王爱[1] 王廷丽[3] Ma Wenguo;Wang Chengde;Wang Ai;Wang Tingli(Department of Burn and Plastic Surgery,Yidu Central Hospital of Weifang,Weifang 262500,China;Interventional Therapy Department,Yidu Central Hospital of Weifang,Weifang 262500,China;Department of Burn and Plastic Surgery,Lai Yang Central Hospital of Yan Tai,Yan Tai 265200,China)

机构地区：[1]山东省潍坊市益都中心医院烧伤整形外科,262500 [2]山东省潍坊市益都中心医院介入治疗科,262500 [3]山东省烟台市莱阳中心医院烧伤整形外科,265200

出　　处：《中华整形外科杂志》2020年第4期434-436,共3页Chinese Journal of Plastic Surgery

基　　金：坊市卫计委科研项目(wfwsjs_2018_063)。

摘　　要：目的探讨在三维CT血管造影(3D-CTA)技术辅助下,游离肩胛皮瓣修复肢体深度烧伤创面的临床效果。方法2013年1月至2018年6月,山东省潍坊市益都中心医院烧伤整形外科收治四肢深度烧伤创面患者21例,男12例,女9例,年龄17~65岁,病程1~3个月,均采用游离肩胛皮瓣修复。术前行3D-CTA检查,根据检查结果,设计与受区缺损的形状、大小相适应的个性化修复方案。术后观察患者皮瓣成活情况、颜色、质地,以及有无瘢痕挛缩、功能障碍等。结果3D-CTA技术能够明确供、受区解剖学结构,术中操作证实血管走行、分布和术前设计基本一致,术后21例皮瓣全部成活。随访半年至1年,见皮瓣颜色、质地、耐磨性、外观恢复较好,患肢活动功能恢复,背部供区未见明显瘢痕增生,肩关节功能正常。结论游离肩胛皮瓣血供可靠、切取范围大、操作方便、不损伤主干血管及供区隐蔽,是修复肢体深度烧伤创面的理想方法之一。术前行3D-CTA检查,指导手术方案设计及实施,提高了术中血管吻合准确率。Objective With the help of computed tomographic angiography and three dimensional technique,to explore to clinical application of the free scapular flap.Methods From January 2013 to June 2018,21 cases of deep post-burn wounds of limbs were repaired with free scapular flaps.3D-CTA examinations were performed before operation,and the personalized reconstructions were designed according to different shape and size of the defects in the recipient sites.The outcome,color,texture,scar contracture and dysfunction of the flaps were observed.Results The 3D-CTA technique was able to define the anatomical structure of the donor and recipient area before the operation.During the operation,it was found that the course and distribution of blood vessels were basically consistent with the design before the operation.21 flaps survived after the operation.During the follow-up of half a year to one year,the color,texture,and appearance of the flap recovered satisfactorily,the function of the affected limb activity recovered,no obvious scar hyperplasia was found in the dorsal donor area,and the function of the shoulder joint was normal.Conclusions The free scapular flap is one of the ideal methods to repair the deep burn wounds of limbs,which has reliable blood supply,wide range of incision,convenient operation,no damage to the main blood vessels and concealed donor areas.3D-CTA examination before operation guided the design and implementation of operation scheme,which improved the accuracy of intraoperative vascular anastomosis.

关 键 词：三维CT血管造影术 肩胛皮瓣 深度烧伤创面 肢体 

分 类 号：R6[医药卫生—外科学]