高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用_《中国修复重建外科杂志》

作者：

肖海涛 ¹ , 时莹瑜 ² , 王怀胜 ¹ , 刘勇 ¹ , 张艳阁 ¹ , 岑瑛 ¹

关键词：

高频彩色多普勒超声股前外侧皮瓣穿支皮瓣

DOI：

10.7507/1002-1892.20130040

视频：

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目的探讨术前采用高频彩色多普勒超声检测穿支血管在股前外侧（anterolateral thigh，ALT）皮瓣手术中的应用价值。方法2011年2月－2012年7月，收治8例拟行ALT皮瓣修复手术的患者。男5例，女3 例；年龄21～46岁，平均34岁。其中头皮鳞状细胞癌术后缺损2例，头皮撕脱伤2例，颈部外伤后皮肤软组织坏死1例，腹股沟区隆突性纤维肉瘤术后缺损1例，腹股沟区黑色素瘤术后缺损1例，面部凹陷畸形1例。软组织缺损范围为12 cm × 7 cm～22 cm × 18 cm。术前采用高频彩色多普勒超声检测旋股外侧动脉降支穿支血管，选取管径较粗、流速快、穿肌肉走行距离最短的穿支血管设计皮瓣，并将术前检测结果与术中观察情况进行比较。皮瓣切取范围为14 cm × 9 cm～25 cm × 20 cm。供区均游离植皮修复。结果术前高频彩色多普勒超声检测共发现皮瓣范围内穿支血管19支，术中证实穿支血管18支，准确率为94.7%。术中见穿支血管出肌点及肌肉内走行方向与术前检测基本一致。术后1例出现皮瓣下部分脂肪液化，经换药2周后愈合；其余皮瓣均顺利成活，创面均Ⅰ期愈合。供区植皮均成活。患者均获随访，随访时间4～16 个月，平均8个月。皮瓣色泽、质地良好。结论ALT皮瓣术前应用高频彩色多普勒超声定位并选取合适的穿支血管能有效提高皮瓣切取的准确性。

引用本文： 肖海涛,时莹瑜,王怀胜,刘勇,张艳阁,岑瑛. 高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用. 中国修复重建外科杂志, 2013, 27(2): 178-181. doi: 10.7507/1002-1892.20130040 复制

1.	李利平, P. C. Neligan. 股前外侧游离穿支皮瓣修复头面部和四肢肿瘤切除后软组织缺损. 中国修复重建外科杂志, 2007, 21(4): 340-342.
2.	Rozen WM, Ashton MW, Pan WR, et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery, 2009, 29(1): 16-23.
3.	Tang CL, Wu YC, Lai CH, et al. Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap. J Plast Surg Hand Surg, 2012, 46(5): 335-338.
4.	Tsuchiya S, Nakatsuka T, Sakuraba M. One-sided soft palatal reconstruction with an anterolateral thigh fasciocutaneous flap: Report of two cases. Microsurgery, 2011, 31(2): 150-154.
5.	Kayano S, Sakuraba M, Miyamoto S, et al. Comparison of pedicled and free anterolateral thigh flaps for reconstruction of complex defects of the abdominal wall: Review of 20 consecutive cases. J Plast Reconstr Aesthetic Surg, 2012, 65(11): 1525-1529.
6.	Liang CC, Jeng SF, Yang JC, et al. Use of anteromedial thigh flaps as an alternative to anterolateral thigh flaps for reconstruction of head and neck defects in cancer patients. Ann Plast Surg, 2012. [Epub ahead of print].
7.	Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck, 2004, 26(9): 759-769.
8.	刘会仁, 李瑞国, 高顺红, 等. 股前外侧皮瓣的多普勒探测研究和设计改进. 中国修复重建外科杂志, 2006, 20(7): 722-724.
9.	Masia J, Kosutic D, Clavero JA, et al. Preoperative computed tomographic angiogram for deep inferior epigastric artery perforator flap breast reconstruction. J Reconstr Microsurg, 2010, 26(1): 21-28.
10.	Knobloch K, Gohritz A, Reuss E, et al. Preoperative perforator imaging in reconstructive plastic surgery: current practice in Germany. Plast Reconstr Surg, 2008, 121(1): 183e-184e.
11.	任义军, 任高宏, 金丹, 等. 数字化股前外侧皮瓣的可视技术在临床中的初步应用. 中华创伤骨科杂志, 2008, 10(5): 432-435.
12.	陆声, 徐永清, 张元智, 等. CT血管造影及可视化研究在背阔肌肌皮瓣移植中的临床应用. 中国修复重建外科杂志, 2009, 23(7): 818-821.
13.	Cheng HT, Lin FY, Chang SC. Evaluation of diagnostic accuracy using preoperative handheld Doppler in identifying the cutaneous perforators in the anterolateral thigh flap: A systematic review. Plast Reconstr Surg, 2012, 129(4): 769e-770e.
14.	Heo C, Eun S, Bae R, et al. Distally based anterolateral-thigh (ALT) flap with the aid of multidetector computed tomography. J Plast Reconstr Aesthet Surg, 2010, 63(5): e465-468.
15.	Tsukino A, Kurachi K, Inamiya T, et al. Preoperative color Doppler assessment in planning of anterolateral thigh flaps. Plast Reconstr Surg, 2004, 113(1): 241-246.
16.	陆林国, 徐智章, 刘吉斌, 等. 超声造影增强技术在探索穿支皮瓣血管中的应用. 上海医学影像, 2010, 19(3): 161-164.
17.	陆林国, 徐秋华, 燕山, 等. 高频彩超对穿支皮瓣血管的探索研究. 上海医学影像, 2008, 17(3): 200-202.
18.	Cigna E, Minni A, Barbaro M, et al. An experience on primary thinning and secondary debulking of anterolateral thigh flap in head and neck reconstruction. Eur Rev Med Pharmacol Sci, 2012, 16(8): 1095-1101.

1. 李利平, P. C. Neligan. 股前外侧游离穿支皮瓣修复头面部和四肢肿瘤切除后软组织缺损. 中国修复重建外科杂志, 2007, 21(4): 340-342.
2. Rozen WM, Ashton MW, Pan WR, et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery, 2009, 29(1): 16-23.
3. Tang CL, Wu YC, Lai CH, et al. Salvage for pectoralis major myocutaneous flap failure in head and neck reconstruction by microvascular flap. J Plast Surg Hand Surg, 2012, 46(5): 335-338.
4. Tsuchiya S, Nakatsuka T, Sakuraba M. One-sided soft palatal reconstruction with an anterolateral thigh fasciocutaneous flap: Report of two cases. Microsurgery, 2011, 31(2): 150-154.
5. Kayano S, Sakuraba M, Miyamoto S, et al. Comparison of pedicled and free anterolateral thigh flaps for reconstruction of complex defects of the abdominal wall: Review of 20 consecutive cases. J Plast Reconstr Aesthetic Surg, 2012, 65(11): 1525-1529.
6. Liang CC, Jeng SF, Yang JC, et al. Use of anteromedial thigh flaps as an alternative to anterolateral thigh flaps for reconstruction of head and neck defects in cancer patients. Ann Plast Surg, 2012. [Epub ahead of print].
7. Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck, 2004, 26(9): 759-769.
8. 刘会仁, 李瑞国, 高顺红, 等. 股前外侧皮瓣的多普勒探测研究和设计改进. 中国修复重建外科杂志, 2006, 20(7): 722-724.
9. Masia J, Kosutic D, Clavero JA, et al. Preoperative computed tomographic angiogram for deep inferior epigastric artery perforator flap breast reconstruction. J Reconstr Microsurg, 2010, 26(1): 21-28.
10. Knobloch K, Gohritz A, Reuss E, et al. Preoperative perforator imaging in reconstructive plastic surgery: current practice in Germany. Plast Reconstr Surg, 2008, 121(1): 183e-184e.
11. 任义军, 任高宏, 金丹, 等. 数字化股前外侧皮瓣的可视技术在临床中的初步应用. 中华创伤骨科杂志, 2008, 10(5): 432-435.
12. 陆声, 徐永清, 张元智, 等. CT血管造影及可视化研究在背阔肌肌皮瓣移植中的临床应用. 中国修复重建外科杂志, 2009, 23(7): 818-821.
13. Cheng HT, Lin FY, Chang SC. Evaluation of diagnostic accuracy using preoperative handheld Doppler in identifying the cutaneous perforators in the anterolateral thigh flap: A systematic review. Plast Reconstr Surg, 2012, 129(4): 769e-770e.
14. Heo C, Eun S, Bae R, et al. Distally based anterolateral-thigh (ALT) flap with the aid of multidetector computed tomography. J Plast Reconstr Aesthet Surg, 2010, 63(5): e465-468.
15. Tsukino A, Kurachi K, Inamiya T, et al. Preoperative color Doppler assessment in planning of anterolateral thigh flaps. Plast Reconstr Surg, 2004, 113(1): 241-246.
16. 陆林国, 徐智章, 刘吉斌, 等. 超声造影增强技术在探索穿支皮瓣血管中的应用. 上海医学影像, 2010, 19(3): 161-164.
17. 陆林国, 徐秋华, 燕山, 等. 高频彩超对穿支皮瓣血管的探索研究. 上海医学影像, 2008, 17(3): 200-202.
18. Cigna E, Minni A, Barbaro M, et al. An experience on primary thinning and secondary debulking of anterolateral thigh flap in head and neck reconstruction. Eur Rev Med Pharmacol Sci, 2012, 16(8): 1095-1101.

《中国修复重建外科杂志》

高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用

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《中国修复重建外科杂志》

高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用

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