数字减影血管造影技术在皮瓣移植受区吻合血管选择中的应用价值  

Application value of digital subtraction angiography technology in the selection of anastomotic vessels in the recipient area of flap transplantation

作　　者：李友[1] 巨积辉[1] 唐林峰[1] 张广亮[1] 杜伟伟[1] 黄庆忠 李雷[1] 蒋国栋[1] 侯瑞兴[1] Li You;Ju Jihui;Tang Linfeng;Zhang Guangliang;Du Weiwei;Huang Qingzhong;Li Lei;Jiang Guodong;Hou Ruixing(Department of Hand Surgery,Ruihua Hospital Affiliated to Suzhou University,Suzhou 215104,China)

机构地区：[1]苏州大学附属瑞华医院手外科,苏州215104

出　　处：《中华手外科杂志》2022年第3期196-199,共4页Chinese Journal of Hand Surgery

基　　金：苏州市重点病种诊疗技术专项项目(LCZX202026);姑苏卫生人才培养项目(GSWS2020116)。

摘　　要：目的探讨数字减影血管造影(digital subtraction angiography,DSA)技术在股前外侧皮瓣移植修复手部复杂创面受区吻合血管选择中的应用价值。方法回顾性分析自2018年1月至2019年7月我科治疗的23例复杂手外伤行股前外侧皮瓣修复创面的患者资料,受区均行DSA检查,明确前臂及手的血供情况,包括桡动脉、尺动脉走行及其穿支动脉、掌深弓、掌浅弓、指总动脉及各指动脉的存在与否等。根据DSA结果及血流动态影像,综合评价血管损伤情况和邻近软组织条件,并以此结果选择合适的供血动脉吻合。结果根据DSA结果制定受区手术入路,术中探查受区吻合血管与DSA检查结果一致。23例双叶皮瓣中穿支血管共干15例,不共干8例(均内增压提供皮瓣血供)。受区血管方式:8例与桡动脉主干吻合,6例与尺动脉主干吻合,5例血流桥接吻合(4例桡动脉、1例尺动脉),2例与尺侧下副动脉吻合,1例与肱动脉分支吻合,1例两块皮瓣分别与桡动脉分支及第3指总动脉吻合。术后2例发生血管危象,经探查后好转,所有皮瓣均Ⅰ期存活,远端肢(指)体及皮瓣血运无障碍。其中10例术后3个月行皮瓣修薄整形,术后患者对外形、功能恢复较满意。结论DSA可以清晰显示患侧前臂和手的血管网,发现可能存在的血管损伤,能有效指导皮瓣受区的供血动脉选择,避免肢体二次损伤,提高皮瓣移植的成功率。Objective To explore the application value of digital subtraction angiography(DSA)technology in the selection of anastomotic vessels in the recipient area of anterolateral thigh flap transplantation for repairing complex hand wounds.Methods The data of 23 patients with complex hand injuries treated by our department from January 2018 to July 2019 who underwent anterolateral thigh flap transplantation to repair the wound were retrospectively analyzed.The DSA was performed in the recipient area to determine the blood supply of forearm and hand,including the course of radial artery,ulnar artery and its perforating artery,deep palmar arch,superficial palmar arch,common digital artery and each digital artery.According to the DSA results and dynamic blood flow images,the vascular injury and adjacent soft tissue conditions were comprehensively evaluated,and the appropriate blood supply artery anastomosis was selected according to the results.Results According to the results of DSA,the surgical approach of the recipient area was established.The results of intraoperative exploration of anastomotic vessels in the recipient area were consistent with those of DSA.Among the 23 cases of bilobed flaps,the perforating vessels had common trunk in 15 cases and did not have common trunk in 8 cases(all of them were supplied by internal pressurization).The vascular pattern of the recipient area:8 cases were anastomosed with the main trunk of radial artery,6 cases with the main trunk of ulnar artery,5 cases with flow-through bridge(4 cases with radial artery and 1 case with ulnar artery),2 cases with the inferior ulnar collateral artery,1 case with the branch of brachial artery,and 1 case with two flaps anastomosed with the branch of radial artery and the third common digital artery respectively.The vascular crisis occurred in 2 cases after operation,which recovered after exploration.All the flaps achieved primary survival,and the blood supply of distal limb(finger)and flap was unobstructed.Among them,10 cases underwent skin flap thin

关 键 词：手损伤 外科皮瓣 数字减影血管造影 受区吻合血管选择 

分 类 号：R658.2[医药卫生—外科学]