轴型肌皮瓣移植修复颈胸部难愈性创面

Axial myocutaneous flap transplantation for repair of refractory wound in the cervico-thoracic region

背景:轴型肌皮瓣移植是当前修复各种难愈性创面的常用方法,既往术前皮瓣主要供血动脉的判断方法存在一定的盲目性,因此,探讨一种更为准确的方法尤为必要。目的:介绍轴型肌皮瓣在颈胸部难愈性创面修复与重建中的应用经验。方法:用彩色多普勒血流成像检测62例4种轴型肌皮瓣的主要供血动脉的起点及分支点外径、血管走向、长度及血流动力学参数等情况,根据检测结果设计肌皮瓣,肌皮瓣切取范围9cm×7cm^18cm×13cm。结果与结论:在彩色多普勒血流成像探测肌皮瓣轴型血管中,发现有1例胸背动脉血流缓慢,管壁粗糙,动脉硬化较明显;其余血管探测结果均显示血流顺畅,管壁光滑,无栓塞、硬化现象,亦无血管缺如现象;所检测供血动脉的起点、分支点、外径、血管走向和解剖学层次均能在屏幕上清晰显示,与术中所见完全一致;术后60例创面Ⅰ期愈合,肌皮瓣全部成活;2例肌皮瓣远端部分坏死,经对症处理后成活。全部病例获随访4个月~6年,平均24个月,皮瓣色泽正常、质地良好,功能及外形满意。提示根据创面的具体情况选择适当的带蒂肌皮瓣修复颈胸部难愈性创面可获得满意的功能及外形,彩色多普勒血流成像对轴型肌皮瓣供血血管判断具有简单、直观和无创的特点,对确定轴型肌皮瓣移植术具有指导意义。

BACKGROUND： Axial myocutaneous flap transplantation is the common method for repair of various refractory. This method had certain blindness in judgment of the main arteries in flaps before surgery in the past. Therefore, it is important to develop a more accurate method. OBJECTIVE： To introduce the application experiences of axial myocutaneous flap in repair of refractory wound in the cervico-thoracic region. METHODS： Color doppler flow imaging was used to examine the starting point, branching point, exterior diameter, vessel trend, vessel length and hemodynamic parameters of the main arteries of 4 types flaps from 62 cases. The axial myocutaneous flaps were designed according to the detection. The sizes of the axial myocutaneous flaps ranged from （9 cm×7 cm） to （18 cm×13 cm）. RESULTS AND CONCLUSION： According to color doppler flow imaging, one case of thoracodorsal artery had slow blood flow, rough vascular wall and obvious arteriosclerosis, and the other cases were with smooth blood flow and vascular wall, and without embolism, arteriosclerosis or absence of blood vessel. The starting point, branching point, exterior diameter, vessel trend and anatomic layers of the detected arteries were displayed clearly, in consistency with the results of operation; the flap completely survived in 60 cases with primary healing; distal partial necrosis occurred in 2 cases and was cured by symptomatic treatment. All the cases were followed up for 4 weeks to 6 years, 24 months in average, and the flaps were with a normal color, good texture and satisfactory appearance. Choosing a suitable pedicled musculocutaneous flap for refractory wound in cervico-thoracic region according to specific conditions can achieve satisfactory function and appearance. Color doppler flow imaging is a simple, intuitive and and non-invasive method to judge blood vessels of axial myocutaneous flaps, and can guide the axial myocutaneous flap transplantation.