游离髂腹部（髂骨）皮瓣的血管分型

Blood vessel typing of free ilio-abdominal （ilium） flap

目的 总结游离髂腹部皮瓣及游离髂骨皮瓣移植修复四肢软组织及复合组织缺损的临床经验,探讨游离髂腹部皮瓣及髂骨皮瓣的血管分型. 方法 1996年1月—2013年12月,开展游离髂腹部皮瓣移植修复四肢软组织缺损40例,其中以旋髂浅动脉为蒂18例,以旋髂深动脉为蒂16例,以旋髂浅深动脉共干为蒂6例;采用髂骨皮瓣移植修复四肢复合组织缺损共42例44侧,其中以旋髂浅动脉为蒂8例,以旋髂深动脉为蒂26例32侧,以旋髂浅动脉与旋髂深动脉共干为蒂4例,另有4例术中发现旋髂深动脉无明显穿支进入皮瓣,而采用髂骨瓣加股前外侧皮瓣组合移植. 结果 本组对82例84侧（包括4例髂骨瓣加股前外侧皮瓣组合移植）病例的解剖资料进行回顾性分析,按游离髂腹部皮瓣及髂骨皮瓣的供血血管分为Ⅳ型.Ⅰ型：以旋髂浅动脉为主型,共26例;Ⅱ型：以旋髂深动脉为主型,共42例44侧;Ⅲ型：旋髂浅动脉与旋髂深动脉共干型,共10例;Ⅳ型：即传统型,共4例. 结论 髂腹部供血血管主要有旋髂浅动脉及旋髂深动脉两类,血管解剖有一定变异,手术时应依供血血管的口径、走行及分型灵活选择,充分认识血管分型有助于术后移植组织的顺利成活,提高手术的疗效.

Objective To summarize the clinical experience of free ilio-abdominal flap and free ilium flap in the use of repairing soft tissue and composite tissue defect of limbs, and to investigate the blood vessel type of free ilio-abdominal flap and free ilium flap. Methods From January 1996 to December 2013, 40 cases were used with free ilio-abdominal flap to repair soft tissue defect of limbs. 18 cases with superficial iliac circumflex artery was pedicle;16 cases with deep iliac circumflex artery was pedicle;6 cases with both superficial and deep iliac circumflex artery was pedicle. 42 sides of 40 cases were used free ilium flap to repair composite tissue defect of limbs. 8 cases with superficial iliac circumflex artery was pedicle;26 cases with deep iliac circumflex artery was pedicle;4 cases with both superficial and deep iliac circumflex artery was pedicle;in another 4 cases, perforating branch can not be found in deep iliac circumflex artery, and iliac flap with anterolateral thigh flap was used. Results Retrospectively analyzed the 82 cases （include 4 cases of iliac flap with anterolateral thigh flap） which were used free ilio-abdominal flap and free ilium flap to repair soft tissue and composite tissue defect of limbs From January 1996 to December 2013, we typed the supply blood vessel of free ilio-abdominal flap and free ilium flap in Ⅳtypes. TypeⅠ：mainly as superficial iliac circumflex artery, 26 cases;TypeⅡ：mainly as deep iliac circumflex artery, 44 sides of 42 cases;TypeⅢ：superficial iliac circumflex artery and deep iliac circumflex artery arose from a common stem, 10 cases; Type Ⅳ： traditional type, 4 cases. Conclusion Blood vessel of iliac abdomen mainly include superficial iliac circumflex artery and deep iliac circumflex artery, certain variations of vascular anatomy can be existed. Choice should depend on the vascular diameter, trend, and type during the operation. Fully understand of the type of blood vessel may help the transplanted tissue to survive, and improve the curative effect.