带血管蒂的阔筋膜皮瓣的临床应用

阔筋膜张肌肌皮瓣因包含肌肉，皮瓣较为臃肿，临床应用受限。我们为此将其血供动脉即旋股外侧动脉升支解剖至进入阔筋膜张肌肌门处后，辨明上、中、下３个分支，结扎上、中支及切断相应的肌肉，制成为以下支为血供的阔筋膜皮瓣。皮瓣内包含长而粗且恒定的股外侧皮神经。因此该筋膜皮瓣可以满足修复皮肤缺损并同时重建感觉功能的需求。临床应用已１５例，取得了较好效果。     

代偿性股前内侧游离皮瓣移植

自１９８８年以来，共开展股前外侧游离皮瓣手术１２０余例，其中１０例因见供血皮支系于股前内侧间隙穿出而临时改变为股前内侧皮瓣。据观察此１０例股前中区的供血血管有３种类型；旋股外侧动脉降支内侧支型６例，股浅动脉供血型２例，股动脉直接分支供血型２例。文中还就皮瓣的命名、手术方法以及大腿前中区血管的代偿特点等进行了讨论。     

不同类型的组织瓣修复胫骨近端骨折术后钢板外露伴感染创面的临床效果

目的探讨不同类型的组织瓣修复胫骨近端骨折术后钢板外露伴感染创面的临床效果。方法采用回顾性观察性研究方法。2015年1月—2021年12月, 武警江西总队医院收治11例符合入选标准的胫骨近端骨折术后钢板外露伴感染创面患者, 其中男9例、女2例, 年龄26～61岁。创面位于小腿近端外侧者5例、内侧者2例, 小腿近端内侧及膝下胫前者4例, 清创后创面面积为14 cm×6 cm～22 cm×11 cm, 采用不同类型的组织瓣修复创面, 并根据钢板周围感染情况决定是否立即拆除钢板。应用以包含旋股外侧动脉降支终末细小分支的肌肉为蒂的逆行股前外侧肌皮瓣者3例;应用腓肠肌内侧头肌瓣联合比目鱼肌内侧半肌瓣者6例, 应用腓肠肌外侧头肌瓣联合胫前肌肌瓣者2例, 肌瓣血运稳定后移植健侧大腿薄中厚皮片封闭创面。肌皮瓣切取面积为15 cm×7 cm～18 cm×8 cm, 肌瓣切取面积为6.0 cm×4.0 cm～18.0 cm×12.0 cm。3例应用逆行股前外侧肌皮瓣的患者中2例大腿供瓣区创面经直接缝合关闭, 在1例患者大腿供瓣区创面缝合后未闭合处移植健侧大腿薄中厚皮片予以修复。将8例应用小腿肌瓣者供瓣区切口...     

旋股外侧动脉降支多叶组织瓣修复手部多部位软组织缺损

目的 探讨旋股外侧动脉降支多叶瓣修复手部多部位软组织缺损的手术方法和临床效果。方法对手部多部位软组织缺损15例,采用旋股外侧动脉降支多叶瓣修复,根据手部缺损情况设计股前外侧皮瓣,沿皮瓣穿支血管向远端继续解剖旋股外侧动脉降支,考虑好手部各缺损处间距,按需切取分叶穿支皮瓣、阔筋膜瓣、股直肌肌瓣、股外侧肌肌瓣、股中间肌肌瓣或旋股外侧动脉降支远端肌间隔瓣。形成以旋股外侧动脉降支为主干的一蒂多叶瓣,在肌瓣及阔筋膜瓣上植皮,一次修复手部多部位软组织缺损。 结果 术后无血管危象发生。修复各创面在肌瓣、阔筋膜瓣或旋股外侧动脉降支远端血管肌间隔上植皮均成活良好,外形无臃肿,植皮处恢复保护性感觉,供区创面愈合好,股四头肌肌力及膝关节屈、伸活动均正常。全部病例获得随访,随访时间6 ～ 20个月,平均8.7个月。按中华医学会手外科学会上肢部分功能评定标准：优3例,良9例,可3例,优良率80％。 结论 旋股外侧动脉降支多叶瓣能一次修复手部多部位软组织缺损,缩短手术时间及疗程,手部功能恢复良好,外形满意,是修复手部多部位软组织缺损的理想方法。     

代偿性股前内侧游离皮瓣移植

自1988年以来,共开展股前外侧游离皮瓣手术120余例,其中10例因见供血皮支系于股前内侧间隙穿出而临时改变为股前内侧皮瓣。据观察此10例股前中区的供血血管有3种类型:旋股外侧动脉降支内侧支型6例,股浅动脉供血型2例,股动脉直接分支供血型2例。文中还就皮瓣的命名、手术方法以及大腿前中区血管的代偿特点等进行了讨论。     

代偿性股前内侧游离皮瓣移植

自１９８８年以来，共开展股前外侧游离皮瓣手术１２０余例，其中１０例因见供血皮支系于股前内侧间隙穿出而临时改变为股前内侧皮瓣。据观察此１０例股前中区的供血血管有３种类型：旋股外侧动脉降支内侧支型６例，股浅动脉供血型２例，股动脉直接分支供血型２例。文中还就皮瓣的命名、手术方法以及大腿前中区血管的代偿特点等进行了讨论。     

股前外侧皮瓣移植

股前外侧皮瓣是以旋股外侧动脉降支为血管蒂的皮瓣。1984年罗力生等曾报道应用此皮瓣修复四肢慢性溃疡及烧伤瘢痕挛缩等,获得满意效果。现将此皮瓣移植的有关问题介绍如下。 一、应用解剖 股外侧肌呈扁平核形,前方被阔筋膜张肌及股直肌覆盖,内侧与股中间肌相邻。股外侧肌由旋股     

股前外侧阔筋膜瓣联合股外侧肌肌腱瓣移植修复足背软组织缺损

2002年6月至2007年5月,我们应用旋股外侧动脉降支肌皮穿支或肌间隙皮支为血供的股前外侧阔筋膜瓣,联合切取股外侧肌肌腱瓣行吻合血管移植,一期修复足背血管、肌腱与皮肤缺损5例,取得了满意效果.     

股前外侧阔筋膜瓣联合股外侧肌肌腱瓣移植修复足背软组织缺损

2002年6月至2007年5月,我们应用旋股外侧动脉降支肌皮穿支或肌间隙皮支为血供的股前外侧阔筋膜瓣,联合切取股外侧肌肌腱瓣行吻合血管移植,一期修复足背血管、肌腱与皮肤缺损5例,取得了满意效果.     

股前外侧阔筋膜瓣联合股外侧肌肌腱瓣移植修复足背软组织缺损

2002年6月至2007年5月,我们应用旋股外侧动脉降支肌皮穿支或肌间隙皮支为血供的股前外侧阔筋膜瓣,联合切取股外侧肌肌腱瓣行吻合血管移植,一期修复足背血管、肌腱与皮肤缺损5例,取得了满意效果.     

阔筋膜张肌肌皮瓣的解剖研究与临床应用

目的　探索应用阔筋膜张肌肌皮瓣带蒂移转中 ,部分肌皮瓣发生血供障碍的原因。方法　对 16具 3 2侧用红色乳胶灌注的贮存成人尸体标本 ,进行解剖研究。结果　 12具 2 2侧肌皮瓣供血动脉走行在肌肉内 ;另有 2具 2侧肌内供血动脉与肌肉前缘较大分支并存 ;3具 4侧肌内供血动脉与肌肉深面疏松结缔组织内较大分支并存 ;3具 4侧供血动脉走行在肌肉浅面皮下组织内。解剖研究后临床又应用 8例 ,妥善保护了存在于肌肉前缘及其深浅面的血管 ,手术均获成功。结论该肌皮瓣的供血动脉不仅存在于肌肉内 ,有的在肌肉前缘或深面有较大分支 ,有的存在于肌肉浅面皮下组织内 ,手术中须避免其受到损伤 ,以确保肌皮瓣血供。     

Blood supply of the knee joint. A microangiographic study in children and adults

The knee joint blood supply is derived from a rich anastomosis of the five major constant arteries, namely, the superior medial and lateral, the middle (posterior), and the inferior medial and lateral genicular arteries. Anastomosis also occurs with descending genicular arteries and the anterior tibial recurrent artery. These branches form anastomoses in and around the knee joint, while each major vessel was noted to provide the respective major blood supply to specific areas. The most obvious difference between vascularization of child and adult knees was the separation of vessels and relative avascularity of epiphyseal plate areas; such persisted until closure of the epiphyseal plate. The regions representing the seals of plate closure had less rich vascularization. A rich intraosseous blood supply was defined in the femoral and tibial condyles and the patella. Similarly, the adjacent and superficial soft tissues, including major ligaments and peripheral parts of the menisci, were richly vascularized. Areas of separated vascularization in children may have relevance to epiphyseal injury, growth deformity, Osgood-Schlatter disease, and hematogenous osteomyelitis. In adults, such information may be relevant to high tibial osteotomy, meniscus and cruciate ligament repair, and surgery utilizing the semitendinosus tendon, fascia lata, or patella tendon grafts.     

Anatomic analysis of the vascular network and vascular pedicle of the tensor fascia lata flap (angiographic and cadaver study)

Knowing the vascular network and properties of the vascular pedicle is of crucial importance for elevation of the tensor fascia lata (TFL) transpositional or free flap; therefore, the origin of the lateral circumflex femoral artery (LCFA), its diameter at the site of origin, the length of the vascular pedicle, the number of lateral branches, the number of terminal branches and the anastomosis of the LCFA ascending branch are of utmost importance for successful elevation and clinical application of this flap. The study was conducted on clinical (100 angiographic images of the femoral artery) and autopsy (48 preparations) material. The first part of the study comprised analysis of the angiographic images that were used to obtain the information on LCFA. The diameter of LCFA at its origin was measured to be 0.44 cm, while it was 0.33 cm at the origin of ascending branch. The mean value of the diameter at the bifurcation of the terminal branches of ascending branch (inside tensor fascia lata muscle) was 0.24 cm. It has been established that the vascular pedicle of the tensor fascia lata flap (ascending branch of LCFA) is anastomosed with the superior gluteal artery in all cases. Measurement of the tensor fascia lata muscle revealed an average length of 15.91 cm, width of 3.55 cm and thickness of 1.98 cm. Injection of colour-ink into the ascending branch LCFA that enters directly into the TFL muscle was used to measure the extent of the TFL flap vascularization and on the average, the TFL flap was 20.32 cm long and 16.57 cm wide while the surface was 17.52 cm³.     

内踝前动脉穿支为蒂隐神经-大隐静脉营养血管远端蒂皮瓣的应用解剖

目的为内踝前动脉穿支隐神经-大隐静脉营养血管皮瓣设计提供解剖学依据.方法30侧经动脉内灌注红色乳胶成人下肢标本,解剖观察踝前内侧区的动脉来源、分支分布及其邻近动脉吻合.结果踝前内侧区动脉,前侧来自内踝前动脉和胫前动脉踝上支穿支,外径平均0.6～0.8mm;后侧来自胫后动脉肌间隙支和骨皮穿支,其中胫后动脉的肌间隙支2～3支,平均外径(0.9±1.2)(0.5～2.5)mm,骨皮穿支1～2支,外径(1.3±0.3)(0.7～2.0)mm.动脉穿支均发出骨膜支、深筋膜支、皮支、皮神经及浅静脉营养支,构成隐神经大隐静脉营养血管,以及深、浅筋膜血管网.结论踝前内侧区的隐神经、大隐静脉、筋膜及皮肤营养血管同源,呈明显的纵向性分布.设计以内踝前动脉筋膜穿支为蒂的隐神经-大隐静脉营养血管皮瓣,远端蒂的旋转点在内踝尖平面,可用于转位修复前足的软组织缺损.     

Histological comparison of autogenous canine fascia lata, Gore-Tex, lyophilized human fascia lata, and autogenous canine vein for vascular patch graft material in a canine arteriotomy model.

Autogenous fascia lata has found little clinical use as a vascular patch graft material. Previous experience, however, suggests that it possesses attributes that might make it useful in this regard. To assess its efficacy as a vascular patch graft, nine adult mongrel dogs each underwent four arteriotomies with placements of patch grafts. The four sites included both carotid arteries and both femoral arteries. In each animal, one of four patch graft materials (autogenous canine fascia lata, Gore-Tex, lyophilized human fascia lata, and autogenous canine vein) were placed as patch material at the arteriotomy site utilizing 7-0 running sutures and loop magnification. The site for placement of each graft material was rotated serially in the animals so that each site would have equal numbers of all four graft materials applied. The animals were killed at either 6 to 8 weeks or 11 to 12 weeks after angiography of all four vessels. The specimens were then evaluated histologically. No difference was observed among any of the patch graft materials with regard to myofibroblast plaque formation. Inflammatory responses were noted to be substantially less in the canine fascia lata group than in the other three groups. Granuloma formation, however, appeared to be most significant in the autogenous canine vein group. Only one vessel was occluded. Aneurysm or pseudoaneurysm formation was not noted in any specimen. It appears from the above results that autogenous fascia lata may be an appropriate alternative to currently utilized arterial patch graft materials and that it should be evaluated further for this purpose.     

隐神经-大隐静脉营养血管远端蒂复合瓣的解剖学研究

目的探讨隐神经-大隐静脉营养血管远端蒂复合瓣的解剖学结构,为临床手术提供依据。方法对30侧经动脉灌注红色乳胶的成人下肢标本进行解剖,并观察隐神经-大隐静脉营养血管的来源、分支、吻合及其与胫骨、比目鱼肌血供的关系。结果由近及远,隐神经-大隐静脉营养血管来自隐动脉3~5支,外径0.7±0.4mm;膝下内动脉皮支,外径0.7±0.2mm;胫后动脉肌间隙支2~7支,外径1.0±0.2mm,其肌支营养比目鱼肌内侧半;骨皮穿支1~2支,外径1.3±0.3mm;踝前内侧穿支,外径0.6±0.2mm;踝上穿支,外径0.8±0.3mm。各穿支穿深筋膜时,发出深筋膜支、骨膜支、皮支和神经静脉血管,构成骨膜、深筋膜和皮神经浅静脉3个层面的血管丛。结论隐神经-大隐静脉营养血管与肌、骨及皮营养血管同源,是构成隐神经-大隐静脉营养血管远端蒂复合瓣的解剖学基础。     

带前臂外侧皮神经营养血管筋膜皮瓣的应用解剖

目的：为带前臂外侧皮神经及其营养血管筋膜皮瓣提供形态学基础。方法：在３２侧成人上肢标本上，观测前臂外侧皮神经营养血管及其周围皮肤的供血情况。结果：前臂外侧皮神经近侧的血供为肱动脉末端和桡动脉起始部的肌皮支，起始处外径分别为１．４ｍｍ、１．１ｍｍ，穿出深筋膜前长为１．９ｃｍ、１．４ｃｍ；远侧主要为桡动脉的粗大皮支，起始处外径为０．８ｍｍ，穿出深筋膜前长０．８ｃｍ；此外，桡动脉的茎突返支及掌浅支的皮支营养其远端。其神经支在神经束间或神经旁相互吻合构成纵向（链式）血管网，并借分支与筋膜皮支所形成的皮下筋膜血管网沟通。结论：可设计带前臂外侧皮神经及其营养血管的筋膜皮瓣，顺行或逆行转位修复邻近部位的软组织缺损。     

Angiographic analysis of the tensor fascia lata vascularized flap

Vascularisation of the flap of tensor fasciae latae originates from the ascending branch of the lateral circumflex femoral artery which enters through the medial side of fascia lata tensor as a dominant branch. Knowing the vascular and characteristics of a vascular peduncle is of great importance while taking the flap, so knowing the site of the source of lateral circumflex femoral artery diameter at the source, the number of the terminal branches and the number of ascending branch anastomoses of lateral circumflex femoral artery are the basic significance for successful taking of the flap and its clinical application. Our investigations were done on clinical material, and the study was based on investigations of angiographies of the femoral artery. Measuring the diameter in the source of ascending branch we found that it was 33 mm while the diameter in the bifurcation of the terminal branches of ascending branch was 2.41 mm in average. The length of vascular peduncle of ascending branch was 68.88 mm in average. Vascular peduncle of the flap of tensor fasciae latae has appropriate length and diameter for microvascular anastomosis.     

Micro Perfusion and Quantitative Analysis of the Femoral Head Intraosseous Artery

The present study investigates the feasibility of micro perfusion of femoral head specimens from femoral neck fracture patients by the inferior retinacular arteries and performing intraosseous artery quantitative analysis of the femoral head. Twelve femoral neck fracture patients who had undergone conventional hip replacement surgery were included in this study. Femoral head specimen arteries were first dissected and exposed and then perfused by the inferior retinacular arteries and all the femoral heads underwent micro‐CT scanning. After micro‐CT scanning, a digital 3‐D model was reconstructed to quantify the femoral head intraosseous arteries for comparison with a normal femoral head. The artery length density, artery volume density, and artery length/volume ratio were calculated separately and compared with normal femoral head parameters. Micro‐CT scanning displayed the epiphyseal arterial network structure and their fine vascular branches in all 12 femoral neck fractures. Blood was supplied from the inferior retinacular artery to the epiphyseal arterial network then to all the fine blood vessels within the femoral head. No statistical differences were observed in femoral heads’ intraosseous artery length densities or volume densities between the normal and femoral neck fracture specimens, while the artery length/volume ratio showed a statistical difference, and the ratio increased from 19 to 46. Micro perfusion of the femoral head by the inferior retinacular arteries is possible and can present the epiphyseal network and their fine arterial branches in pathologic conditions to provide a morphological basis for the study of femoral head disease.     

上臂内侧皮瓣血管的解剖学研究

目的:本研究旨在通过对上臂内侧皮瓣深筋膜浅层以上血管的解剖学研究,为临床应用上臂内侧扩张皮瓣提供理论指导。方法:新鲜成人上肢标本10侧,左右各半,乳胶灌注血管。四倍放大镜下由浅入深进行解剖,观察浅筋膜层内血管的吻合情况、吻合支的数量及皮动脉穿出深筋膜的位置。结果:上臂内侧自深筋膜浅层平面发出的皮动脉8～9支,各皮动脉于深筋膜浅层内发出分支沿纵行方向相互吻合。上臂皮瓣的中轴部位即内侧肌间隔区域吻合支最为丰富,其次为上臂内侧偏后部分。每侧肢体均有2～5支明显的贯串上臂全长的吻合支,多位于皮瓣的中部及偏后侧部位。皮动脉穿出点集中在臂内侧肌间隔区域,最远分支距肘横纹(3.47±1.50)cm,近端分支距腋窝横皱襞距离(1.64±1.22)cm。结论:上臂内侧皮瓣血供介于轴型皮瓣与任意型皮瓣之间,切取时长宽比例超过任意型皮瓣。皮瓣为双向供血,无论以近端为蒂还是以远端为蒂切取皮瓣均是安全的。以内侧肌间隔为轴线,沿深筋膜浅层设计顺行或逆行皮瓣血供均可靠,切取皮瓣安全,如需扩大切取皮瓣,向后扩展延伸比向前扩展血供更可靠。皮瓣制作时蒂部尽可能置于肌间隔区域,蒂宽约4cm。以近端为蒂时,扩张器剥离腔隙近端距腋窝横皱襞需超过3cm,远端为蒂时,扩张器剥离腔隙远端距肘横纹需超过5cm。