应用彩色多普勒血流显像技术设计轴型皮瓣修复足跟深度创面

Design of axial flaps with color Doppler flow imaging technique for repairing deep wounds of heels

目的 探讨利用彩色多普勒血流显像(colorDopplerflowimaging, CDFI)技术设计下肢轴型皮瓣修复足跟部深度创面的方法和疗效,以克服既往设计轴型皮瓣时血管不能直观显像的缺陷。 方法 根据足跟部创面的特点,选用下肢不同部位的轴型皮瓣修复创面,包括腓肠神经营养血管皮瓣10例、足底内侧皮瓣9例、小腿内侧皮瓣6例共25个皮瓣,术前传统方法设计皮瓣后,应用具有高分辨率的多功能彩色多普勒影像仪检测轴型皮瓣供血动脉的起止点、外径、血管走向和长度等,根据检测结果再次设计皮瓣并转移覆盖创面,并将术中所见血管情况与CDFI的显示结果进行对照和比较。 结果 CDFI所检测血管的起止点、外径、血管走向和解剖学层次均能在屏幕上清晰显示,与术中所见一致。术后25例轴型皮瓣全部成活,愈合良好;外观、颜色及功能均满意。 结论 CDFI对下肢轴型皮瓣血管判断具有简单、直观和无创的特点,为确定轴型皮瓣移植术提供更为科学、准确的依据,值得继续深入研究和推广应用。

Objective To report the methods and effect of axial pattern flap on lower limb in repairing deep wounds of heels by using color Doppler flow imaging (CDFI) technique so as to solve the ever before problems that the vessel can not be displayed in designing axial flap. Methods Suitable axial flaps on lower limbs were selected according to the character of the wounds. There were 25 flaps including 10 cases of the distal-based sural neurovascular flap, nine medial sole flap and six medial leg flap. All the axial pattern flaps were designed on the basis of traditional design ways before operation; then, CDFI appliance with high resolution was used to examine the starting spot, exterior diameter, trail and length of the flap’s major artery. The flaps were redesigned according to the results of CDFI and transferred to cover the wounds. In the meantime, both the results of operation and examination were compared. Results The major artery’s starting spot, exterior diameter, trail and anatomic layers were displayed clearly, in consistency with the results of operation. The flaps survived completely and recovered well, with perfect appearance, color and arthral function. Conclusions CDFI is a simple, macroscopic and atraumatic method for designing the axial pattern flap on lower limb, can provide more scientific and accurate evidence for preoperative determination of flap transplantation and is worthy of clinical application.