应用彩色多普勒影像技术设计腹部轴型皮瓣修复手腕部深度创面

Design of abdominal axial flaps with color Doppler flow imaging technique for repairing deep wounds of the hand and wrist

目的报道应用彩色多普勒影像技术设计腹部轴型皮瓣修复手腕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。方法根据手腕部创面的特点,选用腹部不同部位的轴型皮瓣进行修复,其中应用腹股沟皮瓣41例,下腹壁皮瓣15例,脐旁皮瓣6例,共62块皮瓣。术前按传统方法设计皮瓣后,应用彩色多普勒显像仪,检测轴型皮瓣内供血动脉的起止点、外径、血管走行和长度；根据检测结果重新设计皮瓣,术中将皮瓣内所见血管情况与术前彩色多普勒显示的结果进行对比。结果彩色多普勒所检测皮瓣内血管的起止点、外径、血管走行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62例轴型皮瓣全部存活,术后随访6～30个月,所有皮瓣在外观、感觉及功能等方面均较满意。结论彩色多普勒显像对腹部轴型皮瓣内血管的判断具有简单、直观和无创的特点,为确定轴型皮瓣移植术提供了更为科学、准确的依据。

Objective To report the methods and accuracy of using color Doppler flow imaging technique to visualize the axial vessel in axial flap design on inferior belly for repairing deep wounds of the hand and wrist. Methods Appropriate axial flaps on inferior belly were selected according to the characters of the wounds. There were 62 flaps including 41 groin flaps, 15 inferior epigastric flaps and 6 para-umbilical flaps . All the axial flaps were first designed in conventional way. Then, high resolution color Doppler imaging used to examine the starting spot, exterior diameter, course and length of the flaps＇ major artery. The flaps were readjusted according to the results of the images. During flap harvesting, the axial vessels of the flaps were observed under direct visualization and compared with the Doppler images. Results Color Doppler could clearly visualize the starting spot, exterior diameter, course and anatomic layers of the axial artery, in consistency with the intraoperative findings. The flaps survived completely and recovered well, with satisfactory appearance, sensation and function. Conclusion Color Doppler imaging is a simple, macroscopic and atraumatic method to assist designing axial flap on inferior belly. It provides more scientific and accurate evidence for preoperative flap design and is worthy of clinical application.