摘要
目的探讨CT血管造影(CTA)及三维重建在组织瓣修复颈肩、腋窝及上臂高压电烧伤创面中的应用价值。方法2014年12月-2017年12月,笔者单位收治高压电烧伤颈肩、腋窝、上臂等部位的患者12例,行彻底清创后创面面积为13cm×10cm^32cm×15cm。组织瓣修复术前行锁骨下动脉-腋动脉-肱动脉及其分支CTA检查,三维重建主要目标血管及分支,观察拟切取组织瓣利用的轴心血管及其分支血管的显影情况。对上臂及截肢残端骨外露创面、腋窝及前侧创面,结合CTA检查如胸背动脉及内外侧支显影良好,首选背阔肌肌组织瓣修复。本组有6例患者采用此肌皮瓣,切取面积16cm×12cm^32cm×17cm,供瓣区均取大腿中厚皮覆盖。对大面积枕部、颈肩部创面,结合CTA检查创面对侧颈横动脉颈后浅降支及深支,如显影良好,首选对侧下斜方肌肌皮瓣修复;小面积颈肩部创面,结合CTA检查创面同侧颈横动脉浅降支显影良好,选择同侧下斜方肌肌皮瓣修复。本组有4例患者采用此肌皮瓣,切取面积18cm×12cm^25cm×17cm。1例患者供瓣区直接拉拢缝合,3例患者取大腿中厚皮覆盖。对上臂后内侧、腋窝前侧等创面,如无须肌肉填塞无效腔,或因背部烧伤等原因不能利用背阔肌肌皮瓣时,结合CTA检查侧胸部皮肤血供来源可靠,采用侧胸皮瓣修复。本组有2例患者采用此皮瓣,切取面积16cm×12cm^17cm×14cm。1例患者供瓣区直接拉拢缝合,1例患者取大腿中厚皮覆盖。结果本组12例患者术中行组织瓣修复时,观察轴心血管的走行方向、起始位置与术前CTA检查所观察到的情况一致,术后组织瓣全部成活。随访1个月~2年,患者均较满意,无严重瘢痕挛缩影响功能,未继发感染或慢性溃疡。结论颈肩、腋窝及上臂高压电烧伤创面,修复术前应用CTA及三维重建技术能清晰重建锁骨下动脉一腋动脉一肱动脉主干及其分支血管,明确血管有无栓塞,观察血管的起始位置及走行方向,能为选取组织瓣修复创面提供重要参考。
Objective To explore the application value of computed tomography angiography (CTA)and three-dimensional reconstruction in repairing high-voltage electrical burn wounds in necks, shoulders,axillas,and upper arms with tissue flaps.Methods From December 2014to December 2018, 12 patients with high-voltage electrical burns in necks,shoulders,axillas,and upper arms were hospitalized.The size of wounds ranged from 13cm×10cm to 32cm×15cm after complete debridement.Before tissue flap repair,the subclavian artery-axillary artery-brachial artery and their branches were examined by CTA.The main target vessels and their branches were conducted by three-dimensional reconstruction,and the development of the axis vessels for the tissue flaps planning to dissect and their branches were observed. For wounds in upper arms,amputation stump bone exposed wounds,and wounds in axillas and the anterior,the latissimus dorsi myocutaneous flap is the first choice for repair,if the thoracodorsal artery and internal and external branches are well developed according to CTA examination.Latissimus dorsi myocutaneous flaps were used in 6patients with the area of myocutaneous flap ranging from 16cm×12cm to 32cm×17cm. All the donor sites were covered by split-thickness skin graft of thighs.For large wounds in occiputs,necks, and scapulas,the contralateral lower trapezius myocutaneous flap is the first choice for repair,if the superficial descending branch and deep branch of the contralateral transverse cervical artery are well developed according to CTA examination.For small wounds in necks and scapulas,the ipsilateral lower trapezius myocu- taneous flap can be used for repair,if the superficial descending branch of the ipsilateral transverse cervical artery is well developed according to CTA examination.Lower trapezius myocutaneous flaps were used in 4patients with the area of myocutaneous flap ranging from 18cm×12cm to 25cm×17cm.The donor site of one patient was sutured directly and the donor site of the other 3patients was covered by split-thickness skin graft of thighs.For wounds in the posteromedial side of upper arms and the anterior side of axiflas,the lateral thoracic skin flaps can be used for repair,if the latissimus dorsi myocutaneous flap can not be utilized for reasons of back burn or no muscle is needed for dead space,when the blood supply of side chest skin is reliable according to CTA examination.Lateral thoracic skin flaps were used in 2patients with the area of skin flap ranging from 16cm×12cm to 17cm×14cm.The donor site of one patient was sutured directly and the donor site of the other one patient was covered by split-thickness skin graft of thigh.Results During the operation of tissue flap repair in 12patients,the orientation and starting position of the axis vessels were consistent with those observed by CTA examination before operation.All the tissue flaps survived after operation.During follow-up of I to 24 months,the patients were satisfied with no serious scar contracture af- fecting the function nor secondary infection or chronic ulcer.Conclusions CTA and its three-dimensional reconstruction technique can clearly reconstruct the subclavian artery-axillary artery-brachial artery and their branches before repair of high-voltage burn wounds in necks,shoulders,axillas,and upper arms.It can be used to observe whether the vessels are embolized or not and the starting position and orientation of bIood vessels,which can provide an important reference for the selection of tissue flap transplantion.
作者
杨智斌
牛建栋
马勇
李津宁
沈江涌
姚明
Yang Zhibin;Niu Jiandong;Ma Yong;Li Jinning;Shen Jiangyong;Yao Ming(Department of Burns and Plastic Surgery General Hospital of Ningxia Medical University,Yinchuan 750004,China)
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2018年第12期874-880,共7页
Chinese Journal of Burns
基金
宁夏医科大学科学研究基金(XM2016071)。
关键词
烧伤
电
血管造影术
外科皮瓣
移植
Burns,electric
Angiography
Surgical flaps
Transplantation
