CAJ | 학술논문

目的探讨穿支定位在腹壁瘢痕患者切取腹壁下动脉穿支皮瓣(DIEP)时的作用. 方法术前用多排螺旋CT血管造影(MDCTA),以确定有未被损伤及足够粗的腹壁下动脉皮瓣穿支,术中探查已定位穿支血管,分离腹壁下动脉穿支及皮瓣,二期乳房再造1例. 结果术前最优穿支体表定位位置与术中吻合,最大穿支位置位于脐水平左侧约2.8 cm处的垂直下方2.0 cm,内径1.3 mm.皮瓣成活好,术后随访半年,再造乳房外形良好,总体修复效果优良. 结论腹壁瘢痕并非DIEP皮瓣的绝对禁忌手术指征,术前MDCTA可提供准确的腹壁下动脉穿支解剖学信息,术中探查最优穿支血管,保证了皮瓣的血运.穿支定位可作为原瘢痕区切取皮瓣的术前常规检查.
목적 탐토천지정위재복벽반흔환자절취복벽하동맥천지피판(DIEP)시적작용. 방법 술전용다배라선CT혈관조영(MDCTA),이학정유미피손상급족구조적복벽하동맥피판천지,술중탐사이정위천지혈관,분리복벽하동맥천지급피판,이기유방재조1례. 결과 술전최우천지체표정위위치여술중문합,최대천지위치위우제수평좌측약2.8 cm처적수직하방2.0 cm,내경1.3 mm.피판성활호,술후수방반년,재조유방외형량호,총체수복효과우량. 결론 복벽반흔병비DIEP피판적절대금기수술지정,술전MDCTA가제공준학적복벽하동맥천지해부학신식,술중탐사최우천지혈관,보증료피판적혈운.천지정위가작위원반흔구절취피판적술전상규검사.
Objective To investigate the effect of perforator identification before DIEP flap dissection for the patient with abdominal scar.Methods Preoperative multidetector-row computed tomography angiography was used to identify that the dominant perforators of the abdominal wall were not damaged completely.During the second stage breast reconstruction operation,the located dominant perforator and the DIEP flap were dissected.Results The dominant perforator located by MDCTA was identified with the exploration in operation.Follow-up for half a year,the flap survived well and the patient was satisfied with the appearance.Conclusion Abdominal scar was not the definite contraindication for DIEP flap.MDCTA provided a good quality evaluation of the perforator vessels.The located dominant perforator was dissected to confirm the blood supply of the DIEP flap.Identification of perforator can be used as a routine preoperative evaluation for patients with scar on donor site.