中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2011年
5期
508-513
,共6页
袁辉宗%史增元%尹维刚%毛海蛟%董文伟
袁輝宗%史增元%尹維剛%毛海蛟%董文偉
원휘종%사증원%윤유강%모해교%동문위
胫动脉%外科皮瓣%胫骨%尸体解剖%外科手术
脛動脈%外科皮瓣%脛骨%尸體解剖%外科手術
경동맥%외과피판%경골%시체해부%외과수술
Tibial arteries%Surgical flaps%Tibia%Autopsy%Surgical procedures,operative
目的 探讨小腿前肌间隔动脉链为蒂的岛状皮瓣修复胫骨外露的术式及手术方法.方法 40侧成人尸体下肢标本经动脉灌注红色乳胶,4侧新鲜成人尸体下肢标本动脉造影,观测小腿前肌间隔内的胫前动脉穿支与腓动脉终末前穿支的位置、走行、外径及相互吻合.临床应用小腿前外侧岛状皮瓣转位修复胫骨外露11例.男7例,女4例;年龄20～59岁,平均36岁.结果 40侧标本腓骨长度为(32.3±2.4)cm.胫前动脉发出腓浅动脉、胫前动脉下段前肌间隔穿支,与腓动脉终末前穿支在小腿前肌间隔内相互吻合,形成动脉链,这三条动脉外径分别为(1.4±0.4)mm、(1.0±0.4)mm及(1.5±0.4)mm,动脉链吻合处外径为(0.6±0.2)mm.动脉链伴腓浅神经走行,营养神经和小腿前外侧皮肤.临床应用小腿前外侧岛状皮瓣修复胫骨外露的11例中,以胫前动脉下段前肌间隔穿支为蒂2例,以胫前动脉下段前肌间隔穿支的升支为蒂3例,以胫前动脉下段前肌间隔穿支的降支为蒂3例,以腓动脉终末前穿支升支为蒂3例.皮瓣切取面积7 cm×5 cm～13 cm×5 cm.随访1～3年,平均1.5年,11例皮瓣全部成活,无破溃、臃肿.结论 根据皮肤缺损部位、面积等灵活选用小腿前肌间隔内动脉链为血管蒂,设计前外侧岛状皮瓣修复胫骨外露,术式灵活,是修复胫骨外露的理想皮瓣.
目的 探討小腿前肌間隔動脈鏈為蒂的島狀皮瓣脩複脛骨外露的術式及手術方法.方法 40側成人尸體下肢標本經動脈灌註紅色乳膠,4側新鮮成人尸體下肢標本動脈造影,觀測小腿前肌間隔內的脛前動脈穿支與腓動脈終末前穿支的位置、走行、外徑及相互吻閤.臨床應用小腿前外側島狀皮瓣轉位脩複脛骨外露11例.男7例,女4例;年齡20～59歲,平均36歲.結果 40側標本腓骨長度為(32.3±2.4)cm.脛前動脈髮齣腓淺動脈、脛前動脈下段前肌間隔穿支,與腓動脈終末前穿支在小腿前肌間隔內相互吻閤,形成動脈鏈,這三條動脈外徑分彆為(1.4±0.4)mm、(1.0±0.4)mm及(1.5±0.4)mm,動脈鏈吻閤處外徑為(0.6±0.2)mm.動脈鏈伴腓淺神經走行,營養神經和小腿前外側皮膚.臨床應用小腿前外側島狀皮瓣脩複脛骨外露的11例中,以脛前動脈下段前肌間隔穿支為蒂2例,以脛前動脈下段前肌間隔穿支的升支為蒂3例,以脛前動脈下段前肌間隔穿支的降支為蒂3例,以腓動脈終末前穿支升支為蒂3例.皮瓣切取麵積7 cm×5 cm～13 cm×5 cm.隨訪1～3年,平均1.5年,11例皮瓣全部成活,無破潰、臃腫.結論 根據皮膚缺損部位、麵積等靈活選用小腿前肌間隔內動脈鏈為血管蒂,設計前外側島狀皮瓣脩複脛骨外露,術式靈活,是脩複脛骨外露的理想皮瓣.
목적 탐토소퇴전기간격동맥련위체적도상피판수복경골외로적술식급수술방법.방법 40측성인시체하지표본경동맥관주홍색유효,4측신선성인시체하지표본동맥조영,관측소퇴전기간격내적경전동맥천지여비동맥종말전천지적위치、주행、외경급상호문합.림상응용소퇴전외측도상피판전위수복경골외로11례.남7례,녀4례;년령20～59세,평균36세.결과 40측표본비골장도위(32.3±2.4)cm.경전동맥발출비천동맥、경전동맥하단전기간격천지,여비동맥종말전천지재소퇴전기간격내상호문합,형성동맥련,저삼조동맥외경분별위(1.4±0.4)mm、(1.0±0.4)mm급(1.5±0.4)mm,동맥련문합처외경위(0.6±0.2)mm.동맥련반비천신경주행,영양신경화소퇴전외측피부.림상응용소퇴전외측도상피판수복경골외로적11례중,이경전동맥하단전기간격천지위체2례,이경전동맥하단전기간격천지적승지위체3례,이경전동맥하단전기간격천지적강지위체3례,이비동맥종말전천지승지위체3례.피판절취면적7 cm×5 cm～13 cm×5 cm.수방1～3년,평균1.5년,11례피판전부성활,무파궤、옹종.결론 근거피부결손부위、면적등령활선용소퇴전기간격내동맥련위혈관체,설계전외측도상피판수복경골외로,술식령활,시수복경골외로적이상피판.
Objective To explore surgical methods of repairing tibial skin defect using the anterolateral crural island flap.Methods The location,external diameters,anastomosis and distribution of perforators from the anterior tibial artery and the peroneal artery in the anterior septum were observed in 40 cadaveric specimens.Arterial angiography was performed in 4 fresh legs.Clinically,11 cases with tibial skin defect were repaired with the anterolateral crural island flap.There were 7 males and 4 females,with an average of 36 years (20-59 years).The area of the skin defect ranged from 6 cm×4 cm to 12 cm×4 cm.Results An arterial chain was formed by the interconnection of the superficial peroneal artery,the anterior septocutaneous perforator from distal part of the anterior tibial artery and the anterior end-perforator of the peroneal artery.It ran in the anterior septum and went along with the superficial peroneal nerve to supply blood to adjacent fascia and skin.The external diameters of the three perforators were (1.4±0.4) mm,(1.0±0.4) mm and (1.5±0.4) mm respectively,and the external diameter of the arterial chain was (0.6±0.2) mm.Clinically,we designed 4 methods to repair 11 cases of tibial skin defect successfully with the anterolateral cnnal island flap.The anterior septocutaneous perforator from distal part of the anterior tibial artery was used as pedicle in 2 cases;ascending branch of the anterior septocutaneous perforator from distal part of the anterior tibial artery was used as pedicle in 3 cases;descending branch of the anterior septocutaneous perforator from distalpart of the anterior tibial artery was used as pedicle in 3 cases;ascending branch of the anterior end-perforator of the peroneal artery was used as pedicle in 3 cases.The area of the flaps ranged between 7 cm×5 cm and 13 cm×5 cm.All patients were followed up with a mean time of 1.5 years.All flaps survived totally without diabrosis and swelling.Conclusion The anterolateral island flaps pedicled with perforators arising from the anterior septum of the lower leg is a good choice for surgeons to repair tibial skin defect.
