手持多普勒超声在股前外侧皮瓣修复足部缺损中的应用  

Application of handheld Doppler ultrasound in repairing foot defect with anterolateral thigh flap

作　　者：张国雷 李文庆 朱小弟 王文胜 谭荣志 ZHANG Guo-lei;LI Wen-qing;ZHU Xiao-di;WANG Wen-sheng;TAN Rong-zhi(Department of Hand and Foot Surgery,Xie He Shenzhen Hospital of Huazhong University of Science and Technology,Shenzhen 518052,Guangdong Province,China)

机构地区：[1]华中科技大学协和深圳医院手足外科,广东深圳518052

出　　处：《中国临床解剖学杂志》2020年第5期597-599,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的利用手持多普勒超声观察研究股前外侧皮瓣(anterolateral thigh flap,ALTF)穿支血管的体表位置与数量,为ALTF设计提供依据。方法术前在髂前上棘与髌骨外上缘连线(α线),其中点(A点)与腹股沟韧带股动脉搏动点(B点)连线(β线),β线即为旋股外侧动脉降支的体表投影。应用手持多普勒超声于β线及以A点为中心半径为3 cm圆形区域内寻找皮穿支,予以标记,以穿支搏动最明显处设计股前外侧皮瓣。我科于2016.04-2019.09,临床应用8例,均为下肢软组织缺损,皮瓣最大21 cm×10cm,最小8 cm×6 cm。结果股前外侧皮瓣皮穿支大部分位于A点周围,其中粗大的穿支均位于A点下外侧。本组皮瓣8例,7例全部成活,1例皮瓣远端部分表皮坏死,经换药后自行愈合。术后门诊随访512个月,皮瓣成活,外形及功能良好。结论术前应用手持多普勒超声,能有效定位股前外侧皮瓣可靠的穿支,从而提高皮瓣切取的准确性与安全性,减少手术时间。Objective To provide reference for anterolateral thigh flap(ALTF) design by using handheld Doppler ultrasound to observe the surface position and number of the ALTF perforating vessels.Methods Before the operation, line α was the connection between the anterior superior iliac spine and the upper superior patella. Line β was the connection between the point A and the pulsation point(B) of the pulse point of femoral artery under inguinal ligament, which was the surface projection of the descending branch of the lateral femoral circumflex artery. The handheld Doppler ultrasound was used to find the perforating branches in the circular area with the radius of 3 cm centered on the point A, and the anterior anterolateral thigh flaps were designed with the most obvious perforator pulsation. There was 8 cases of clinical applying in our department from Apr. 2016 to Sep. 2019, all of which were soft tissue defects of lower limbs, the largest flap size was 21 cm × 10 cm, the smallest 8 cm × 6 cm. Results Most of the anterolateral thigh flaps were located around point A, and the thick perforators were located outside the point A. For 8 cases of flaps, 7 cases all survived, 1 case had partial epidermal necrosis at the distal end of the flap, and which healed after dressing change. After 5~12 months of outpatient follow-up, the flap survived well, the shape and function were good. Conclusions Preoperative application of handheld Doppler ultrasound can effectively locate the reliable perforating branch of the anterolateral thigh flap, thereby improving the accuracy and safety of flap removal and reducing the operation time.

关 键 词：旋股外侧动脉降支 穿支皮瓣 创面修复 软组织缺损 

分 类 号：R616.2[医药卫生—外科学] R658[医药卫生—临床医学]