腓肠神经营养血管蒂逆行岛状皮瓣应用前的评估方法探讨(1)
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[摘要]目的:探讨临床应用腓肠神经营养血管蒂逆行岛状皮瓣的术前评估方法,以提高手术的安全性。方法:对拟运用腓肠神经营养血管蒂逆行岛状皮瓣修复足踝部、跟部、胫前下1/3软组织缺损的患者术前常规行下肢静脉血管造影,于足背静脉注射造影剂,了解下肢浅静脉干及其伴行侧支在设计皮瓣蒂部的位置,在皮瓣旋转点上方上止血带,了解深静脉通畅情况及其深浅交通支的位置是否存在并是否通畅。应用超声多谱勒血流探测仪了解设计皮瓣蒂部动脉穿支位置,并标记。结果:临床应用11例患者,其中9例深浅静脉均通畅,在皮瓣旋转点附近均可见明显的深浅静脉交通支,深浅静脉均畅通, 于外踝处、皮瓣轴线周边及拟设计皮瓣旋转点以下可探测到明显的动脉穿支,应用腓肠神经营养血管蒂逆行岛状皮瓣一期成活,1例患者旋转点以下无明显深浅静脉交通支,另一例患者于胫后多谱勒血流探测仪未探测到明显的动脉穿支,改行其它皮瓣修复创面。结论:术前应常规应用下肢静脉血管造影及超声多谱勒血流探测仪探测设计皮瓣蒂部动脉穿支的方法,可有效提高此类手术的安全性。
[关键词]缺损;修复;腓肠神经
[中图分类号]R622[文献标识码]A[文章编号]1008-6455(2010)07-0963-03
To discuss the method of Preoperative evaluatet the safe of reversed sural neurofasciocutaneous flap
SHENG Hui,TIAN Heng-jin,JING Shu-lin,WANG Zhi-yong,ZHANG Zhi-jia
(Department of Plastic and Hands Surgery,the People'sHospital of Taixing,Taixing 225400,Jiansu,China)
Abstract: ObjectiveTo introduce the method of preoperative evaluatet the safety of reversed suralneurofasciocutaneousflap.MethodsIntravenous angiographywere been applifdfor preoperative of reversed suralneurofasciocutaneousflap.The tourniquet tied up the pedice of flap Reversed suralneurofasciocutaneous flap to approach the position of communicans deep vein and lower vein. Doppler blood survey meter was been applied todecide the perforator artery of malleolus lateralis.Results11 cases were been applied. The communicans deep vein and lower vein were been fonud exist and unblocked andthe perforator artery of malleolus lateralis.were been decided around ankle in 9 cases;The eversed suralneurofasciocutaneousflaps in 9 patiens all survived completely after operation. The raw surface were been repaired by other flapsin 2 cases,which 1cases not been fonud the communicans deep vein and lower and the other perforator artery of malleolus lateralis not been decided.ConclusionsThe safety of reversed suralneurofasciocutaneousflap could been approved by the method of Intravenous angiography and Doppler blood survey meter before operation
Key words:defect;repair;sural nerve
足踝部、跟部、胫前下1/3软组织缺损多由外伤所致,由于其特定的解剖结构和部位,其修复一直是整形外科、骨科医师面临的难题。自从“神经营养皮瓣”的概念和浅静脉营养血管皮瓣概念的提出,下肢可形成小隐静脉-腓肠神经营养血管逆行岛状筋膜皮瓣广泛应用于临床,特别适合在基层医院开展,我科2003年至2007年应用此类皮瓣修复下肢各种创面20例,术后出现皮瓣静脉回流障碍10例,导致皮瓣部分或全部坏死,手术失败率较高,2007年以来,我科对拟应用此类皮瓣修复下肢创面的在术前常规进行下肢静脉血管的造成影和多谱勒血流探测到外踝处动脉穿支,以评估此类手术的安全性现总结报道如下 ......
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