胸锁乳突肌锁骨头蒂半片锁骨瓣修复锁骨肩峰端的应用解剖学

目的 为修复锁骨中远端骨不连提供新的手术方法，方法 在４０例成人颈部标本上，观察胸锁乳突肌锁骨头的形态，血供及其与锁骨的关系，结果 锁骨头无损伤可分离长度为８．１ｃｍ，其主要血供为甲状腺上动脉胸锁孔突肌支，人肌点在该肌的肌前缘后１．７ｃｍ，距锁骨上缘６．８ｃｍ处结论 可设计以胸锁乳突肌锁骨头为蒂半片锁骨瓣移行行锁骨头中远端骨下连修复的术式。     

胸锁乳突肌肌瓣血管的巨微解剖

文献中对胸锁乳突肌中、下段肌动脉来源的记载很不一致。本文用50例成人标本,以巨微解剖方法,用图确切显示肌的上、中、下段分别主要由枕动脉、颈外动脉和甲状腺上动脉的肌支供应。锁骨下动脉分支发出的附加肌支(39/50)常分布肌的起端,但分布范围小,不是肌的主支。胸锁乳突肌肌支来源多,采用该肌任一头作肌瓣时,应将多源的肌支分别保留于各头,以利单头肌瓣和剩余肌的存活。采取游离血管蒂时,以用颈外动脉或甲状腺上动脉肌支为佳。这两个肌支位置表浅,管径平均都是1.1mm。各肌支都是分散入肌的,没有形成血管门。     

胸大肌皮瓣移植术后护理体会

胸大肌皮瓣是一个带血管的轴型复合组织瓣，1979年由阿伦(Ariyan)氏首先发表，此后，在我国相继开展应用。胸大肌皮瓣移植手术是切取自体带有血液循环的胸肩峰动脉的胸肌支，以此血管为基础携带胸大肌表面的皮肤，用于面部、颈部、口腔及咽喉等处软组织损伤的整复重建。我院1992～2002年，应用胸大肌皮瓣移植术治疗患者20例，效     

胸大肌血管神经蒂的显微外科解剖学

根据胸大肌肌皮瓣带蒂移植的要求,我们解剖测量了80例成年尸体的胸肩峰血管、胸最上动脉、胸外侧血管和胸前神经起点的粗细、支数、长度及体表投影。 1、胸大肌肌皮瓣的血液主要由胸肩峰动脉胸大肌支供应,同时接受胸最上动脉或胸外侧动脉供应者占6.25％。 2.血管胸大肌支的支数为2～4支,以2支的最多见,占61.25％。其管径,第     

胸大肌上半部翻转移位代三角肌术

本文报告应用胸大肌上半部翻转移位法重建三角肌功能,效果满意。胸大肌上下两部各有独立的止腱及血管神经系统,手术时保留血管神经蒂,将胸大肌上半部肌肉起止点完全游离,并向外翻转移位,一端固定于锁骨外端、肩峰和肩胛角,另一端固定于肱骨三角肌粗隆。由于移位后肌肉酷似三角肌,增加了力臂,术后效果明显优于斜方肌     

胸大肌肌皮瓣在耳鼻咽喉—头颈部晚期癌手术中的应用

１９９２年３月以来，我科应用胸大肌肌皮瓣修复头颈部晚期癌大范围切除术后造成的组织缺损共６例，其中腮腺癌术后颈淋巴结转移侵犯皮肤１例，颈部皮肤恶性黑色素瘤１例，扁桃体咽侧壁癌２例，颊部恶性淋巴瘤１例，上颌窦癌１例。６例均为一期重建，皮瓣全部成活。胸大肌肌皮瓣成功的关键在于完好地保护胸肩峰动脉之胸肌支。本文就胸肩峰动脉胸肌支的有关解剖、手术中的注意事项等进行了讨论。     

肩部血管蒂骨膜(骨)瓣的解剖学基础与术式设计

目的 :为肩部带血管蒂骨膜 (骨 )瓣移位治疗肩关节周围骨不连、骨缺损、肱骨头缺血性坏死的术式设计提供解剖学依据。方法 :在 4 0侧经动脉内灌注红色乳胶的成人上肢标本上 ,观察并测量肩关节周围动脉网有关血管的起始、走行、分支、分布及吻合情况。结果 :肩关节周围动脉网有关血管来自 :①胸肩峰动脉 ,主要分支中锁骨支长度 (2 .0± 0 .1)cm、外径 (1.2± 0 .2 )mm ;肩峰支长度 (5 .1± 0 .4 )cm、外径 (1.5± 0 .2 )mm ;三角肌支外径 (1.9± 0 .2 )mm ,发出点至三角肌和胸大肌入肌点长度分别为 (4 .8± 0 .5 )cm和 (3.2± 0 .4 )cm。②旋肱前动脉 ,主要分支中外侧降支长度 (6 .0± 0 .7)cm、外径 (1.2± 0 .2 )mm ,起点距肱骨大结节最高点为 (4 .1± 0 .7)cm ;内侧降支外径 (1.0± 0 .7)mm ,起点距肱骨头最高点距离为 (4 .0± 0 .6 )cm。③旋肱后动脉 ,其大结节骨膜支起点外径 (1.2± 0 .2 )mm ,供骨面积为 3.0cm× 5 .0cm。④肱动脉肌间隙支发升支直接骨膜支 ,上行连接旋肱前动脉内侧降支 ,其外径 (1.1± 0 .3)mm。上述动脉存在丰富的吻合。结论 :以肩部血管为蒂的骨膜 (骨 )瓣 ,是治疗肩关节周围骨不连、骨缺损及骨坏死的重要供区之一     

胸大肌上半部翻转移位代三角肌术

对6例三角肌病废造成肩外展功能丧失患者,施行胸大肌上半部翻转移位法重建三角肌功能,效果满意。手术时保留血管神经蒂,将胸大肌上半部肌肉起止点完全游离,并向外翻转移位固定于锁骨外端、肩峰及肱骨三角肌粗隆.术后随访功能改善明显肩外展除1例为40°外,另5例为70～90°,前屈上举60～150°,胸大肌大部分功能仍得到保留     

以跗外侧动脉为蒂的足上侧皮瓣的应用解剖

为修复足跟部，手背部和虎田区软组织损提供质地优良的供区。方法：选择１０侧动脉灌注红色乳胶的新鲜足标本，２０例防腐固定的下肢标本，对其跗外侧动脉的走行，分支分布和类型进行了了解剖学观测。结果：跗外侧动脉在行程过程中，发出筋膜皮支，拇短伸肌支，趾短伸肌支，趾短伸肌肌皮支，骰骨支和跗外侧动脉终支。     

术前超声血管定位在胸大肌岛状瓣设计中的应用

摘要 目的: 探讨术前超声血管定位能否提高胸大肌岛状皮瓣的速度和安全性。 方法：41例患者进行头颈肿瘤一期重建,所有患者采用岛状皮瓣修复,其中超声处理组21和对照组20例。在超声处理组中,术前超声描记处胸肩峰动脉的走行及其最下入肌点,同时标记第四或第五胸廓内动脉的穿支血管起点。画一条从最下入肌点到第四或第五胸廓内动脉穿支起点的直线,以这条直线为轴设计胸大肌岛状皮瓣。在对照组没有超声标记,术者要仔细辨别胸肩峰动脉最下入肌点和胸廓内动脉穿支起点。 结果:在超声标记组,从锁骨中点到胸肩峰动脉的距离为5.1±1.2 cm( ±S,以下同) ,从开始设计到转移皮瓣时间为51 ± 10.5 分钟,而对照组为 78 ± 13.9 分钟,两者差异显著（p<0.01）。在治疗组和对照组,皮瓣部分坏死率分别为 4.7 %(1/21) 和35%(7/20) 。在对照组,1例患者因胸大肌岛状瓣制作术中损伤解剖最下入肌点,造成该血管损伤而放弃。 结论：术前超声检查能缩短胸大肌岛状皮瓣的手术时间, 并能有效提高手术安全性。     

A NEW FLAP CLINICAL EXPERIENCE OF ACROMIOTHORACIC CUTANEOUS FREE FLAP FOR REPAIR OF DEFECTS IN THE ORAL AND MAXILLOFACIAL REGION

Since December 1986, acromiothoracic cutaneous flap (with its blood supply from the cutaneous perforators of deltoid muscular branches of thoracoacromial vessels) has been used for repair of the defects in the oral and maxillofacial region on 7 cases. All falps in this group survived. This skin flap must be very promising with advantages of an unexposed donor site, soft in texture and color matching the face. Moreover, the operation is less traumatic. The design and essential points of preparing the flap are introduced. The indication of operation is also discussed.     

Use of preoperative ultrasound in designing the true pectoralis major myocutaneous island flap

Background  Traditional techniques used for harvesting the pectoralis major myocutaneous (PMMC) flap have accompanying disadvantages, such as the necessity for an upper chest skin incision, the bulkiness of myocutaneous tissue at the pedicle of the flap, and the risk of total or partial necrosis of flap tissue. The aim of this study was to develop a safe and fast method for preparing PMMC island flaps using preoperative ultrasonography for vessel detection.

Methods  Forty-one PMMC island flaps were used for one-stage reconstruction of head and neck defects, including 21 cases in the treatment group and 20 cases in the control group. In the treatment group, ultrasonography was used to mark out the course of the thoracic branches of the thoracoacromial artery and the lower end of this artery perforating from the fascia into the muscles, as well as the largest perforating branch of the fourth or fifth internal mammary artery entering the PMMC flap. A line, from the lower end of the thoracic branch to the largest perforating branch of the fourth or fifth internal mammary artery, was drawn to determine the axis of the PMMC flap. In the control group, PMMC island flaps were designed according to conventional methods without using ultrasonography.

Results  According to the ultrasonic marks, the distance from lower end of thoracic branch to the midpoint of the margin of the inferior clavicular was (5.1±1.2) cm. The time from designing to transferring the island flap was significantly shorter in the treatment group ((51.0±10.5) minutes) compared with the control group ((78.0±13.9) minutes, P <0.01). The rate of partial necrosis was 4.7% (1/21) in the treatment group and 35.0% (7/20) in the control group. There was one case of flap failure in the control group due to vascular injury during vascular pedicle dissection.

Conclusion  Preoperative vessel detection by ultrasonography facilitates easy and safe harvesting of the true PMMC island flap.

     

胸大肌胸肋部肌蒂骨(膜)瓣修复肱骨骨不连的应用解剖

目的 为带胸大肌胸肋部肌蒂骨(膜)瓣转位修复顽固性肱骨骨不连提供解剖学依据。方法 在30侧成人尸体标本上，观测了胸大肌胸肋部的形态、血供及其与肋胸骨的关系。结果 胸肋部肌腹上缘长18．8cm，下缘长19．5cm，肌蒂游离长度可达16．8cm，血供主要来自胸肩峰动脉胸肌支，其外径1．8mm，长度为5．6cm，其分支在肌内沿肌束走行。结论 可设计以胸大肌胸肋部为蒂带肋软骨骨膜、胸骨骨瓣转位修复顽固性肱骨骨不连。     

带蒂胸大肌皮瓣修复口腔颌面部缺损的临床应用研究

目的：探讨带蒂胸大肌皮瓣修复口腔颌面部肿瘤切除后组织缺损的方法及疗效,总结其临床经验及相关并发症的原因。方法：2003年7月～2007年12月采用带蒂胸大肌肌皮瓣对67例口腔颌面部因肿瘤术后大型缺损进行即刻修复,并对相关临床资料进行回顾性分析。结果：随访时间6～36个月,61例胸大肌皮瓣全部成活,外观和功能均较为满意;6例发生部分和全部坏死。结论：带蒂胸大肌皮瓣能够修复口腔颌面部较大面积缺损,操作简单易行,手术效果明显,术前充分准备可提高皮瓣成活率。     

阔筋膜张肌游离肌皮瓣的应用解剖

目的:为临床进行阔筋膜张肌游离肌皮瓣移植提供解剖学资料.方法:按局部层次对用福尔马林固定的25具(共50侧)成人尸体进行逐层解剖并观测阔筋膜张肌的血管、神经以及其与临近结构的关系.结果:阔筋膜张肌营养血管主要来自于旋股外侧动脉的升支,其神经主要来自于臀上神经的下支,血管和神经行程较恒定,在分离寻找旋股外侧动脉的升支时,应注意保护浅层的股外侧皮神经.结论:阔筋膜张肌有自身较长的血供和神经来源,是良好的游离肌皮瓣供区.     

阔筋膜张肌瓣修复上肢深度烧伤的解剖研究

目的为提高阔筋膜张肌瓣修复上肢的移植存活率和功能重建的满意度提供解剖依据。方法教学用尸体30具（48侧）及完整下肢5侧，对阔筋膜张肌的血供、神经、肌形及髂胫束进行观察并记录。结果阔筋膜张肌星长梭形，长14．5～17．5cm，宽3．6～4．2cm，厚0．8～1．2cm，髂胫束长25～28cm，宽4～7cm，厚0．5cm，由臀上神经下支支配。旋股外侧动脉分支3支型占74％，2支型占24％，1支型占2％；阔筋膜张肌由升支供血占77％，升横支共同供血占23％；升横共干占75％，升横分叉存在4种位置，近肌前缘和深面分叉的横支分支至阔筋膜张肌（12侧），也分出浅皮支（21侧）至阔筋膜皮肤。结论阔筋膜张肌瓣以升支或升横干、降支为肌、皮双血管蒂，带阔筋膜张肌神经、股前外侧皮神经，修复上肢深度烧伤，血运丰富，运动和感觉功能存在。阔筋膜瓣以横支浅皮支和降支为双血管蒂，带股前外侧皮神经，修复无肌肉缺损上肢烧伤，血运充足，感觉存在。     

The application of island myocutaneous flap for challenging wounds on cervico-thoracic region

Objective: To introduce the experiences in the application of island myoculaneous flap for challenging wound on cervico-thoracic region. Methods: Different myocutaneous flaps were selected according to the location, peculiarity and etiological factor of wound. There were 28 cases of island pectoralis major island myocutanuous flaps, 34 cases of latissimus dorsi island myocutaneous flaps. 19 cases of trapizius island myocutaneous flaps and 17 cases of rectus abdominis island myocutaneous flaps in this report. Results: All 98 patients with challenging wound on cervico-thoracic region were successfully treated with this method without complications, and obtained functional and cosmetic effectiveness. Conclusion : Challenging wounds in cervico-nuchal region can be repaired with pertoralis major island myoculaneous flap, latissimus dorst island myocutaneous flap and trapizius island myocutancous flap, while challenging wounds in thoracic region can be repaired with latissimus dorsi island myocutaneous flap and rectus abdominis island myocutaneous flap. Satisfactory functional and cosmetic results can be obtained.     

Reconstruction of upper chest wall defects with a function-preserving pectoralis major muscle flap: case report

The pectoralis major muscle or myocutaneous flap has a nearly 100% success rate in reconstructing chest wall defects. Major adverse sequelae resulting from the use of the pectoralis major muscle or myocutaneous flap are rarely reported in the literature. However, the loss of pectoralis major muscle function caused by the detachment of the muscle from its insertion on the humeral bone is of more and more concern. This is a significant loss for manual laborers when the patient tries to handle tools or control heavy machinery. A case of upper sternal osteomyelitis is reported. After wide debridement with partial excision of the sternum, the second and third ribs, the right pleura, and the lung were exposed. A right unilateral pectoralis major muscle flap was transposed to restore the defect. In addition, to preserve the lateral portion of the muscle and its insertion on the humerus, the origin of the lower sternocostal part of the pectoralis major muscle was transposed to the medial clavicle and residual upper sternum. In this way, not only was the chest wall defect reconstructed but the function of the residual pectoralis major muscle was also preserved. Postoperative follow-up at one year demonstrated no arm weakness, no limitation in shoulder range of motion, and no evidence of atrophy of the transposed pectoralis major muscle. Our experience with this function-preserving pectoralis major muscle flap was encouraging and we suggest it be employed in the reconstruction of the upper anterior chest wall.     

3种肌(皮)瓣在口腔颌面部缺损修复中的应用

目的：探讨3种肌（皮）瓣移植在口腔颌面部组织缺损修复中的临床效果和适应证。方法：对28例口腔颌面部组织缺损患者分别采用前臂皮瓣、胸大肌肌皮瓣、额瓣进行移植修复。结果：28例中完全成活25例。大部分成活1例，移植成功率为92．8％，完全坏死2例．部分坏死1例；前臂皮瓣全部成活13例，全部坏死1例；胸大肌肌皮瓣全部成活10例，部分坏死1例．全部坏死1例：2例额瓣全部成活。颌而部外形、丰满度及表情功能恢复良好，口腔功能明显改善。结论：3种肌（皮）瓣均可较好地修复口腔颌面部的组织缺损，但应根据缺损的组织量、部位、缺损范围选用不同的组织瓣。