胸背动脉穿支皮瓣的显微解剖及临床应用

Microsurgical anatomy and clinical application of thoracodorsal artery perforator flap

目的观察胸背动脉穿支的显微解剖特点,探讨应用胸背动脉穿支皮瓣(TAP)修复手部软组织创面的临床疗效。方法2014年10月至2014年11月,对10侧成人尸体胸背标本,用红色乳胶灌注腋动脉,解剖、观察、测量并统计胸背动脉穿支数量、血管直径等;2015年1月至2019年2月,对52例伴有骨质、伸肌腱外露的手部软组织缺损患者采用TAP修复,术后进行门诊随访观察临床疗效。结果胸背动脉穿支为2~4条,以3条最多,穿支外径0.22~0.68 mm,穿支入皮点距腋后襞的距离5.2~11.8 cm。52例皮瓣手术顺利,供区均直接关闭缝合;48例皮瓣成活,2例部分坏死,2例完全坏死,通过换药、游离植皮后伤口愈合。随访5~24个月,皮瓣血运良好,质地柔软,不过分臃肿,外观评价良好。结论TAP切取皮瓣厚度薄,供区隐蔽,直接缝合后遗留瘢痕不明显,对供区的功能及美观影响小,是一种理想的皮瓣。

Objective To investigate the microsurgical anatomy of thoracodorsal artery perforators,and the clinical effect in repairing the soft tissue defect of hand with the thoracodorsal artery perforator flap(TAP).Methods From October,2014 to November,2014,the axillary arteries in 10 thoracodorsal specimens were perfused with red latex.The number and diameter of the perforators of the thoracodorsal arteries were mearsured.From January,2015 to February,2019,52 cases of soft tissue defects in hand combined with bone and extensor tendon exposure were repaired with TAP.The patients were followed-up in outpatient department to observe the clinical efficacy.Results The number of perforators of thoracodorsal artery was 2-4 mostly,and 3 perforators was the most.The diameter of perforators was 0.22-0.68 mm,and the distance between the perforating point and the posterior axillary wall was 5.2-11.8 cm.All the operations were completed successfully,and the donor sites were closed directly.In 52 cases,48 flaps survived,2 had partially necrosis,and 2 had completely necrosis.The patients were followed-up for 5 to 24 months.The blood supply of the flaps was good with soft texture and good appearance.Conclusion The TAP is an ideal flap because of its thin in thickness,concealed donor area and no obvious scar after direct suture.