CAJ | 학술논문

目的探讨采用邻近角形穿支筋膜皮瓣,修复躯干部中小面积缺损的解剖学基础与临床应用效果.方法 ①动脉灌注红色乳胶的成人防腐标本10具(20侧),行解剖观测躯干部体表血供的来源以及血管走行、分支与分布及交通吻合情况.②在解剖学基础上设计应用邻近角形穿支筋膜皮瓣修复躯干部皮肤缺损创面15例,修复缺损范围5 cm×5 cm～13 cm×13cm,切取的皮瓣面积10cm×6cm～35 cm×15 cm.结果躯干部体表皮肤供血主要为甲状颈干、胸廓内动脉、肋间后动脉、腹壁上动脉、腹壁下动脉、腰动脉等17组源动脉.胸部、腹部和会阴部、上背部、腰部外径大于0.5 mm的穿支数分别约为20、40、24、6支.临床应用15例邻近角形穿支筋膜皮瓣均成活,供、受区创口愈合良好,经1个月至2年随访,色泽、质地、外形恢复较好.结论根据躯干部缺损的部位、大小设计相应的邻近角形穿支筋膜皮瓣,其设计灵活,手术创伤小,供区可直接拉拢缝合,无需植皮,是修复躯干部较大面积缺损的一种有效、优质、简便的方法.
목적 탐토채용린근각형천지근막피판,수복구간부중소면적결손적해부학기출여림상응용효과.방법 ①동맥관주홍색유효적성인방부표본10구(20측),행해부관측구간부체표혈공적래원이급혈관주행、분지여분포급교통문합정황.②재해부학기출상설계응용린근각형천지근막피판수복구간부피부결손창면15례,수복결손범위5 cm×5 cm～13 cm×13cm,절취적피판면적10cm×6cm～35 cm×15 cm.결과 구간부체표피부공혈주요위갑상경간、흉곽내동맥、륵간후동맥、복벽상동맥、복벽하동맥、요동맥등17조원동맥.흉부、복부화회음부、상배부、요부외경대우0.5 mm적천지수분별약위20、40、24、6지.림상응용15례린근각형천지근막피판균성활,공、수구창구유합량호,경1개월지2년수방,색택、질지、외형회복교호.결론 근거구간부결손적부위、대소설계상응적린근각형천지근막피판,기설계령활,수술창상소,공구가직접랍롱봉합,무수식피,시수복구간부교대면적결손적일충유효、우질、간편적방법.
Objective To study the anatomy basis for the clinical application of the adjacent horn shaped perforator fasciocutaneous flap for the reconstruction of small and medium-sized defects in the trunk area.Methods ①Ten adult antiseptic cadavers (20 sides) were perfused with red latex.The skin blood supply,line of the blood vessels,branches in accordance with the distribution and crossing were observed.②Fifteen cases with defects in the trunk were treated with the adjacent horn shaped perforator fasciocutaneous flaps.The defects size ranged from 5 cm × 5 cm to 13 cm × 13 cm with the size of the flaps ranging from 10 cm ×6 cm to 35 cm × 15 cm.Results The trunk skin is supplied by mainly 17 groups arteries such as thyrocervical trunk,internal thoracic artery,posterior intercostal arteries,superior epigastric artery,arteria epigastrica inferior,lumbar arteries,and so on.The perforators (diameter ＞0.5 mm) numbers are about 20,40,24,6,on the chest,abdomen and perineum,upper back,waist,respectively.All the flaps survived completely with primary healing both on donor and recipient sites.The flaps color,texture,function and appearance were satisfactory during the follow-up period of 1-24 months.Conclusions The adjacent horn shaped perforator fasciocutaneous flap should be designed flexibly.The defects in the donor sites could be closed directly without skin graft.It is an effective,easy and ideal method for the reconstruction of large defects in the trunk.