CAJ | 학술논문

目的探讨切取股上部直接皮动脉皮瓣的解剖学依据并回顾其临床疗效.方法对20侧灌注红色乳胶成人尸体下肢标本,进行解剖学观察;对其中2侧新鲜下肢标本,予股上部直接皮动脉灌注中华墨汁,观察皮瓣墨染范围.在50例股前外侧皮瓣切取手术中,对发现的股上部直接皮动脉进行追踪解剖.观察股上部直接皮动脉的出现率、动脉起始来源、走行并测量其管径.临床对42例皮肤软组织缺损的患者.采用股上都直接皮动脉皮瓣移植修复.结果 20侧灌注红色乳胶成人下肢标本,股上部直接皮动脉血管出现率为75.0%(15侧,15条).其中2侧新鲜下肢标本,股上部直接皮动脉皮瓣墨染面积分别为11.0 cm×18.0 cm、11.0 cm×19.0 cm.观察50例股前外侧皮瓣切取手术中,股上部直接皮动脉出现率为72.0%(36例,36条).出现的这51条股上部直接皮动脉中,血管起源类型有三种:起源于旋股外侧动脉(共29条,占56.9%);起源于股深动脉(共8条,占15.7%);起源于股动脉(共14条,占27.4%).股上部皮支血管从起点发出后,向大腿外下方于深、浅筋膜之间走行人皮肤,其穿出点多位于髂前上棘-髌骨外上缘连线中点上方3.0 cm、外侧2.5cm范围内,行程[(10.7±3.3)cm,(x)±s,下同].起始外径(2.7±0.2)mm,伴行静脉外径分别为(2.8±0.4)mm、(2.4±0.3)mm.本组42例股上部直接皮动脉皮瓣,皮瓣切取面积为6.0 cmx8.0cm～11.0cm×18.0 cm(游离皮瓣11例,带蒂皮瓣31例).术后3例皮瓣边缘部分坏死,经换药和皮片移植后愈合,其余皮瓣全部存活.结论该皮瓣血供良好,不携带肌肉,切取容易,可携带股前外侧皮神经,既可带蒂转移,亦可作吻合血管的游离移植.
목적 탐토절취고상부직접피동맥피판적해부학의거병회고기림상료효.방법 대20측관주홍색유효성인시체하지표본,진행해부학관찰;대기중2측신선하지표본,여고상부직접피동맥관주중화묵즙,관찰피판묵염범위.재50례고전외측피판절취수술중,대발현적고상부직접피동맥진행추종해부.관찰고상부직접피동맥적출현솔、동맥기시래원、주행병측량기관경.림상대42례피부연조직결손적환자.채용고상도직접피동맥피판이식수복.결과 20측관주홍색유효성인하지표본,고상부직접피동맥혈관출현솔위75.0%(15측,15조).기중2측신선하지표본,고상부직접피동맥피판묵염면적분별위11.0 cm×18.0 cm、11.0 cm×19.0 cm.관찰50례고전외측피판절취수술중,고상부직접피동맥출현솔위72.0%(36례,36조).출현적저51조고상부직접피동맥중,혈관기원류형유삼충:기원우선고외측동맥(공29조,점56.9%);기원우고심동맥(공8조,점15.7%);기원우고동맥(공14조,점27.4%).고상부피지혈관종기점발출후,향대퇴외하방우심、천근막지간주행인피부,기천출점다위우가전상극-빈골외상연련선중점상방3.0 cm、외측2.5cm범위내,행정[(10.7±3.3)cm,(x)±s,하동].기시외경(2.7±0.2)mm,반행정맥외경분별위(2.8±0.4)mm、(2.4±0.3)mm.본조42례고상부직접피동맥피판,피판절취면적위6.0 cmx8.0cm～11.0cm×18.0 cm(유리피판11례,대체피판31례).술후3례피판변연부분배사,경환약화피편이식후유합,기여피판전부존활.결론 해피판혈공량호,불휴대기육,절취용역,가휴대고전외측피신경,기가대체전이,역가작문합혈관적유리이식.
Objective To study the anatomic basis of direct cutaneous artery flap of the upper thigh and review the clinical outcome of its application. Methods The direct cutaneous arteries of the upper thigh were dissected in 20 sides of the adult embalmed cadaverie specimens perfused with red relax. The arteries were perfused with Chinese ink in 2 fresh cadaver specimens to observe the distribution area. During surgical harvesting of anterolateral femoral skin flap in 50 cases, the occurrence rate, source artery, diameter and course of the direct cutaneous arteries of the upper thigh were noted. Forty-two cases of soft tissue defects were repaired with direct cutaneous artery skin flap of the upper thigh. Results Direct cutaneous arteries of the upper thigh oecurred in 15 of 20 sides of the adult embalmed cadaveric specimens perfused with red relax. The occurrence rate thereof was 75.0%. The size of the flaps dyed with Chinese ink was 11.0 cm × 18.0 cm. The occurrence rate of direct cutaneous arteries during dissection of the 50 cases of anterolateral femoral skin flap was 72.0% (36 arteries in 36 cases). Direct cutaneous artery of the upper thigh came from the lateral femoral circumflex artery ( 56.9%, 29 sides), the deep femoral artery( 15.7%, 8 sides) or the femoral artery ( 27.4%, 14 sides ). The mean diameter of origin site. of these direct cutaneous arteries was (2.7 ±0.2) mm. Among the 42 cases of direct cutaneous artery skin flap of the upper thigh, 3 flaps survived with partical necrosis and healed after changing dressing or skin graft. The others survived completely, the size of flaps ranged from 6.0 cm × 8.0 cm to 11.1cm×18.0cm(11 free skim flaps andm 31 pedicle flaPS), Conclusion The direct eutaneous artery skin flap of the upper thigh has good blood supply and is easy to harvest. It can be made into not only pedicled flap but also free transplantable flaps. It is possible to harvest the flap without any muscle. The lateral femoral cutaneous nerve can be harvested and anastomosed with a cutaneous nerve of the recopient site.