CTA联合彩色多普勒超声技术在尺动脉腕上皮支皮瓣穿支血管定位中的临床应用  

Clinical application of CTA combined with color Doppler ultrasound in the localization of perforating vessels of flap based on above wrist cutaneous branch of the ulnar artery

作　　者：陆浩 薛明宇 强力 周晓 Lu Hao;Xue Mingyu;Qiang Li;Zhou Xiao(Department of Hand Surgery,Wuxi the Ninth People's Hospital Affiliated to Suzhou University,Wuxi 214062,China)

机构地区：[1]苏州大学附属无锡市第九人民医院手外科,无锡214062

出　　处：《中华手外科杂志》2022年第4期315-318,共4页Chinese Journal of Hand Surgery

摘　　要：目的探究计算机断层扫描血管造影技术(CTA)联合彩色多普勒超声技术(CDU)在尺动脉腕上皮支皮瓣穿支血管定位中的应用。方法自2019年1月至2020年1月,对10例伴手背或手掌侧软组织缺损患者行尺动脉腕上皮支皮瓣术,创面面积4.5 cm×3.7 cm~8.7 cm×5.5 cm,部分患者.合并掌骨骨折或伸肌腱损伤。术前采用CTA和CDU相结合的方法对其穿支进行定位及验证,在确定穿支的部位和口径后,精准指导设计皮瓣,进行软组织重建修复,切取皮瓣面积5 cm×4 cm~9 cm×6 cm。术后定期随访。结果10例患者术前CTA和CDU相结合的方法定位的穿支血管与术中所见完全吻合,10例尺动脉腕上皮支完全存活,供区无运动感觉功能障碍。术后随访6~12个月,皮瓣质地、外形满意,两点分辨觉为6~8 mm。结论术前运用CTA和CDU相结合的方法可准确定位穿支血管位置,有利于皮瓣更精确的设计,减少受区植皮及皮瓣臃肿的可能,同时减少手术风险和并发症。ObjectiveTo explore the application of computed tomography angiography(CTA)combined with color Doppler ultrasound(CDU)in the localization of perforating vessels of flap based on above wrist cutaneous branch of the ulnar artery.Methods From January 2019 to January 2020,10 patients with dorsal or volar soft tissue defects were treated with flap based on above wrist cutaneous branch of the ulnar artery.The wound area ranged from 4.5 cm×3.7 cm to 8.7 cm×5.5 cm.Some patients were complicated with metacarpal fracture or extensor tendon injury.The perforating branch was located and verified by the combination of CTA and CDU before operation.After determining the position and diameter of the perforating branch,the flap was designed accurately,and the soft tissue was reconstructed and repaired.The area of the flap was 5 cm×4 cm to 9 cm×6 cm.The regular follow-up was performed after operation.ResultsThe perforator vessels located by the combination of CTA and CDU in 1O patients were completely consistent with those seen during the operation.The above wrist cutaneous branch of the ulnar artery in 10 patients survived completely,and there was no motor sensory dysfunction in the donor area.The postoperative follow-up ranged from 6 to 12 months.The texture and shape of the flap were satisfactory,and the two-point discrimination was 6 to 8 mm.ConclusionThe combination of CTA and CDU can accurately locate the position of perforating vessels before operation,which is conducive to the more accurate design of skin flap,reduce the possibility of skin grafting and skin flap bulky in the recipient area,and reduce the risk and complications of operation.

关 键 词：外科皮瓣 血管造影术 彩色多普勒超声 尺动脉腕上皮支 定位 

分 类 号：R445.1[医药卫生—影像医学与核医学] R687.3[医药卫生—诊断学]