摘要
目的探讨基于术前彩色多普勒超声(CDU)和数字减影血管造影(DSA)进行皮瓣血管穿支和浅筋膜分支的精确定位,采用分层切取技术削薄股前外侧皮瓣(ALTF)的应用效果。方法自2023年4月至2023年11月,首都医科大学附属北京积水潭医院手外科采用分层切取方案削薄游离ALTF,修复前臂和手部创面13例(14块皮瓣)。其中男8例,女5例;年龄19~58岁,平均37岁;身体质量指数(BMI)17.30~31.87 kg/m^(2),平均23.64 kg/m^(2)。皮瓣面积9 cm×6 cm~20 cm×13 cm;皮瓣切取厚度4~6 mm,平均5.2 mm。术前首先应用CDU确定穿支血管穿经阔筋膜的入口部位,并进行体表标记;利用DSA技术,于皮瓣切线位再次定位穿支血管的位置及其分支在浅筋膜层的分布。基于术前精确的定位,术中于浅筋膜的深层和浅层之间分层切取削薄的ALTF。术后定期门诊随访。结果14块皮瓣的穿支1~2条,穿支浅筋膜分支2~4条,术前穿支定位与术中穿支入口部位吻合,距离均小于1 cm。所有病例均获随访,随访1~7个月,平均3.2个月。除1例出现供区延迟愈合外,无其他供区并发症。所有皮瓣均顺利成活,皮瓣外观良好,无需二次修整。结论术前CDU和DSA精确定位穿支入口的部位和浅筋膜分支的分布,采用分层切取技术削薄ALTF,该方案有效降低了削薄皮瓣的切取难度,减少了供区损伤。
ObjectiveTo evaluate the application of layered harvesting technique for thin anterolateral thigh flap(ALTF)based on preoperative perforator mapping by colour Doppler ultrasound(CDU)and digital subtraction angiography(DSA).MethodsFrom April 2023 to November 2023,13 patients(14 flaps)with forearm and hand wounds.were treated in the Department of Hand Surgery,Beijing Jishuitan Hospital,Capital Medical University,In this study,they were 8 males and 5 females;aged from 19 to 58 years old,with a mean of 37 years old.Body Mass Index(BMI)was 17.30-31.87 kg/m^(2)with an average of 23.64 kg/m^(2).The flap area was 9 cm×6 cm-20 cm×13 cm;the flap thickness was 4-6 mm with an average of 5.2 mm.Before surgery,CDU was applied to determine the entrance of the perforator vessel and made skin marking.DSA technology was further used to relocate the position of the perforator vessel and the branches of the superficial fascia layer at the flap tangential position.Based on the precise perforator positioning,the thin ALTF was harvested between the deep and superficial layers of the superficial fascia.Regular outpatient follow-ups were conducted after surgery.ResultsThe 14 flaps had 1 to 2 perforators and 2 to 4 superficial fascia branches,and the preoperative positioning coincided with the intraoperative perforator entrance,and the distance was less than 1 cm.All patients were included in the follow-up from 1 to 7 months with a mean of 3.2 months.Only 1 patient had the complication delayed healing at the donor site.All flaps survived successfully and had a good appearance without secondary trimming.ConclusionPreoperative CDU and DSA accurately locate the entrance of the perforator and the distribution of superficial fascial branches,and the layered harvesting technique for thin ALTF,effectively reduces the difficulty at harvesting of the thin flap and reduces damage to the donor site.
作者
杨勇
李斌
李金勇
王丹丹
陈涛
王扬
徐小龙
李峰
王志新
钟文耀
YANG Yong;LI Bin;LI Jinyong;WANG Dandan;CHEN Tao;WANG Yang;XU Xiaolong;LI Feng;WANG Zhixin;ZHONG Wenyao(Department of Hand Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University,Bejing 100035,China;Department of Ultrasound Diagnosis,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2024年第3期248-253,共6页
Chinese Journal of Microsurgery
基金
北京市卫生系统高层次卫生技术人才培养计划(2015-3-036)
北京市医院管理中心“登峰”计划专项经费(DFL20240402)。
关键词
彩色多普勒超声
数字减影血管造影
股前外侧皮瓣
修薄皮瓣
显微外科技术
Colour Doppler ultrasound
Digital subtraction angiography
Anterolateral thigh flap
Thin flap
Microsurgical technique
