摘要
目的 利用手持多普勒超声观察研究股前外侧皮瓣(anterolateral thigh flap,ALTF)穿支血管的体表位置与数量,为ALTF 设计提供依据。 方法 术前在髂前上棘与髌骨外上缘连线(α线),其中点(A点)与腹股沟韧带股动脉搏动点(B点)连线(β线),β线即为旋股外侧动脉降支的体表投影。应用手持多普勒超声于β线及以A点为中心半径为3 cm圆形区域内寻找皮穿支,予以标记,以穿支搏动最明显处设计股前外侧皮瓣。我科于2016.04-2019.09,临床应用8例,均为下肢软组织缺损,皮瓣最大21 cm×10 cm,最小8 cm×6 cm。 结果 股前外侧皮瓣皮穿支大部分位于A点周围,其中粗大的穿支均位于A点下外侧。本组皮瓣8例,7例全部成活,1例皮瓣远端部分表皮坏死,经换药后自行愈合。术后门诊随访5~12个月,皮瓣成活,外形及功能良好。 结论 术前应用手持多普勒超声,能有效定位股前外侧皮瓣可靠的穿支,从而提高皮瓣切取的准确性与安全性,减少手术时间。
Abstract
Objective To provide reference for anterolateral thigh flap (ALTF ) design by using handheld Doppler ultrasound to observe the surface position and number of the ALTF perforating vessels. Methods Before the operation, line α was the connection between the anterior superior iliac spine and the upper superior patella. Line β was the connection between the point A and the pulsation point (B) of the pulse point of femoral artery under inguinal ligament, which was the surface projection of the descending branch of the lateral femoral circumflex artery. The handheld Doppler ultrasound was used to find the perforating branches in the circular area with the radius of 3 cm centered on the point A, and the anterior anterolateral thigh flaps were designed with the most obvious perforator pulsation. There was 8 cases of clinical applying in our department from Apr. 2016 to Sep. 2019, all of which were soft tissue defects of lower limbs, the largest flap size was 21cm × 10cm, the smallest 8 cm×6 cm. Results Most of the anterolateral thigh flaps were located around point A, and the thick perforators were located outside the point A. For 8 cases of flaps, 7 cases all survived, 1 case had partial epidermal necrosis at the distal end of the flap, and which healed after dressing change. After 5~12 months of outpatient follow-up, the flap survived well, the shape and function were good. Conclusions Preoperative application of handheld Doppler ultrasound can effectively locate the reliable perforating branch of the anterolateral thigh flap, thereby improving the accuracy and safety of flap removal and reducing the operation time.
关键词
旋股外侧动脉降支 /
穿支皮瓣 /
创面修复 /
软组织缺损
Key words
  /
Lateral femoral artery descending branch /
Perforator flap /
Wound repair /
Soft tissue defect
张国雷, 李文庆, 朱小弟, 王文胜, 谭荣志.
手持多普勒超声在股前外侧皮瓣修复足部缺损中的应用[J]. 中国临床解剖学杂志. 2020, 38(5): 597-599 https://doi.org/10.13418/j.issn.1001-165x.2020.05.021
ZHANG Guo-lei, LI Wen-qing, ZHU Xiao-di, WANG Wen-sheng, TAN Rong-zhi.
Application of handheld Doppler ultrasound in repairing foot defect with anterolateral thigh flap[J]. Chinese Journal of Clinical Anatomy. 2020, 38(5): 597-599 https://doi.org/10.13418/j.issn.1001-165x.2020.05.021
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参考文献
[1] 李岩松,邓雪峰,林利忠,等. CTA 与多普勒超声穿支动脉定位法在股前外侧皮瓣修复小腿部软组织缺损的临床应用研究[J]. 现代医学,2017, 45( 11) : 1583-1586.
[2] 段家章,何晓清,徐永清 ,等.数字化技术在股前外侧皮瓣修复手足创面中的应用[J]. 中国修复重建外科杂志,2015,29(7):807-811.
[3] 芮永军,张全荣,许亚军,等. 股前外侧皮瓣修复前臂大面积软组织缺损[J]. 中华手外科杂志,2005,21(1):11-12.
[4] 盛美樱,肖灿,贾玉静,等. CTA三维重建技术在股前外侧皮瓣修复口腔颌面部缺损中的应用[J]. 中国美容整形外科杂志,2019,30(6): 348-352.
[5] 林樾,谭谦,王淑,等.股前外侧穿支皮瓣游离移植在复杂创面修复中的应用及其并发症处理[J]. 中国美容医学,2019,28(4):4-8.
[6] 盛健峰.游离股前外侧穿支皮瓣重建头颈肿瘤术后缺损[J]. 中外医学研究,2018,16(28):139-141.
[7] 唐举玉,李康华. 股前外侧皮瓣的临床研究进展[J].中国临床解剖学杂志, 2009, 27(1):111-113 .
[8] 罗力生, 张立宪, 胡志奇.高位直接皮支型股前外侧皮瓣的应用[J].中国修复重建外科杂志, 2001, 15(4):206-207 .
[9] 段家章,何晓清,徐永清. 股前外侧皮瓣血管解剖学及术前皮瓣设计技术研究进展[J]. 中国修复重建外科杂志,2016,30(7):909-914.
[10]Lee YC, Chen WC, Chou TM, et al. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications[J]. Plast Reconstr Surg, 2015, 135(4): 1097-1107.
[11] 徐镭,高鹏飞,徐万林,等. 股前外侧穿支皮瓣的应用解剖研究及临床应用[J]. 中国口腔颌面外科杂志,2015,13(6):502-507.
[12]Choi SW, Park JY, Hur MS, et al. An anatomic assessment on perforators of the lateral circumfl ex femoral artery for anterolateral thigh flap[J]. J Craniofac Surg, 2007, 18(4): 866-871.