CAJ | 학술논문

目的探讨应用多层螺旋CT血管造影(MDCTA)进行术前穿支血管特征评估、指导“freestyle”穿支皮瓣临床应用的效果.方法 2011年2月至2012年12月,对下肢软组织缺损40例术前均采用MDCTA行穿支评估,包括位置、口径、走行、与邻近结构的关系.选择优势穿支设计不同的穿支皮瓣进行软组织修复重建,并评估术前与术中穿支位置的吻合率. 结果应用带蒂螺旋桨穿支皮瓣19例,游离穿支皮瓣21例.术后所有皮瓣均存活,仅1例膝降动脉穿支皮瓣远端出现2 cm×2 cm的坏死,经换药后治愈.供区37例直接关闭缝合,3例通过部分植皮.术前穿支定位与术中所见穿支位置吻合率为97.5％.结论术前MDCTA可以提供准确的穿支解剖学特征信息,在下肢软组织修复重建时,皮瓣的设计更具随意和准确,手术更加简单、安全,从而减少了供区损伤并获得最佳的修复效果.
목적 탐토응용다층라선CT혈관조영(MDCTA)진행술전천지혈관특정평고、지도“freestyle”천지피판림상응용적효과.방법 2011년2월지2012년12월,대하지연조직결손40례술전균채용MDCTA행천지평고,포괄위치、구경、주행、여린근결구적관계.선택우세천지설계불동적천지피판진행연조직수복중건,병평고술전여술중천지위치적문합솔. 결과 응용대체라선장천지피판19례,유리천지피판21례.술후소유피판균존활,부1례슬강동맥천지피판원단출현2 cm×2 cm적배사,경환약후치유.공구37례직접관폐봉합,3례통과부분식피.술전천지정위여술중소견천지위치문합솔위97.5％.결론 술전MDCTA가이제공준학적천지해부학특정신식,재하지연조직수복중건시,피판적설계경구수의화준학,수술경가간단、안전,종이감소료공구손상병획득최가적수복효과.
Objective Significant anatomical variability of perforator vessel can affect the perforator flap application in accuracy,randomness,and the final result of the repair.Multidetector-row computed tomography angiography(MDCTA) is an useful preoperative identification of perforator vessel,and which is discussed as a guidance to the clinical utilities of "free-style" perforator flap in lower extremity.Methods From February 2011 to December 2012,forty patients with soft tissue defects in lower extremity were treated.Preoperatively MDCTA was performed on all patients to assess features of the perforating branches,including their location,caliber,course,structure and relationship of neighboring tissues.Various perforator flaps for soft tissue reconstruction using dominant perforator vessels were designed.Moreover the coincidence rate between preoperative and intraoperative location of the perforator vessel was evaluated.Results All the flaps which consisted of 19pedicled propeller flaps and 21 free flaps survived postoperatively.Only 1 case which involved the descending genicular artery perforator flap presented with a 2 cm × 2 cm distal necrosis which healed after regular dressing.For 37 cases,the donor site were primarily closed while partial skin grafting was performed in 3 cases.The rate of coincidence between the preoperative and intraoperative location of perforating branches was 97.5％.Conclusion Preoperative MDCTA can provide precise anatomical information on the perforator vessel.For sofi tissue defects reconstruction in the lower extremity,MDCTA makes the flap design easier and more accurate,and the surgery simpler and safer,thereby reducing damage to donor site and achieving the best repair.