CAJ | 학술논문

目的探讨腓肠肌血管作为受区血管供养游离皮瓣的临床应用价值. 方法 2005年6月至2011年7月,观察20侧成人下肢标本腓肠肌血管的起始、走行、分支、吻合情况,测量其外径和血管蒂长度,进行手术模拟.通过16侧新鲜成人下肢标本CT影像资料观察一侧血管结扎后对腓肠肌血供影响.以腓肠肌血管供血的小腿严重创伤游离皮瓣移植52例,其中男47例,女5例.年龄23～47岁,平均27岁.结果腓肠肌主要由腓肠内、外侧血管保证血供.腓肠内侧、外侧动脉由腘动脉发出后在腓肠肌深面入肌.腓肠内侧动脉血管蒂长度为8.0 ～ 13.8 cm,平均11.1 cm,动脉外径在入肌处为(1.8±0.3) mm.腓肠外侧动脉血管蒂长度为5.4～12.3 cm,平均8.8 cm.腓肠内、外侧动脉的伴行静脉均为2支,入肌点处外径(2.0±0.4) mm.结扎一侧腓肠动脉后,该侧腓肠肌可以通过交通支获得足够的血液供应.52例游离组织瓣移植全部成活.随访1～2年,患肢创面愈合好,无感染复发,膝关节屈伸活动未受影响. 结论腓肠肌内、外侧血管蒂长,口径较粗,作为伤肢受区血管用于游离皮瓣移植,对伤肢血供影响小,临床应用可靠,大大简化了手术.
목적 탐토비장기혈관작위수구혈관공양유리피판적림상응용개치. 방법 2005년6월지2011년7월,관찰20측성인하지표본비장기혈관적기시、주행、분지、문합정황,측량기외경화혈관체장도,진행수술모의.통과16측신선성인하지표본CT영상자료관찰일측혈관결찰후대비장기혈공영향.이비장기혈관공혈적소퇴엄중창상유리피판이식52례,기중남47례,녀5례.년령23～47세,평균27세.결과 비장기주요유비장내、외측혈관보증혈공.비장내측、외측동맥유객동맥발출후재비장기심면입기.비장내측동맥혈관체장도위8.0 ～ 13.8 cm,평균11.1 cm,동맥외경재입기처위(1.8±0.3) mm.비장외측동맥혈관체장도위5.4～12.3 cm,평균8.8 cm.비장내、외측동맥적반행정맥균위2지,입기점처외경(2.0±0.4) mm.결찰일측비장동맥후,해측비장기가이통과교통지획득족구적혈액공응.52례유리조직판이식전부성활.수방1～2년,환지창면유합호,무감염복발,슬관절굴신활동미수영향. 결론 비장기내、외측혈관체장,구경교조,작위상지수구혈관용우유리피판이식,대상지혈공영향소,림상응용가고,대대간화료수술.
Objective To evaluate clinical application of the gastrocnemius blood vessles as recevier ones to anastomose with free flaps. Methods From June 2005 to July 2011,twenty adult lower limbs were infused with red glue to observe the origin,streching,branches and communication with other blood vessles of the gastrocnemius blood vessles and to measure their outer diameters and pedicle length. Operations were also simulated on these specimens to make the above chacracters of the vessles clear further.CT images of 16 fresh adult lower limbs were got to observe the effects of obstruction of one side of the gastrocnemius blood vessels to the blood supply of the gastrocnemius muscles. Fifty-two free flaps were transplanted to legs with large defects of skin and soft tissues where the gastrocnemius blood vessles were anastomosed with the flaps to supply artery blood and receive vein blood. Results The main blood vessles of the gastrocnemius muscles were medial and lateral gastrocnemius blood vessles. They both origined from the popliteal arteries and communicated with other blood vessles. The pedicles of the medial gastrocnemius blood vessles were 8.0 -13.8 cm in length which averaged 11.1 cm and their outer diameters were (1.8 ± 0.3) mm when they entered the muscles. The pedicles of the medial gastrocnemius blood vessles were 5.4 - 12.3 cm in length which averaged 8.8 cm.The outer diameters of the two accompanying veins were (1.8 ± 0.3)mm when they entered the muscles.When one gastrocnemius blood vessle were obstructed,the gastrocnemius muscles could got enough blood supply by co mmunicating branches between the obstructed vessle and other blood vessles.All the 52 free flaps survived. Through one to two-years follow-up, the defects cured with no infection and the knees' motions were normal. Conclusions With a long pedicle and wide diameter,the medial or lateral gastrocnemius blood vessle can be a reliable alternative used in free flap transplautation for repairing large defects of skin and soft tissues of seriously injured legs with no other choice of blood vessles, which causes unobvious effects to the blood supply of the legs and can simplify the free flap transplantation.