摘要
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。
Objective To investigate the effectiveness of high frequency color Doppler ultrasound for detecting perforators in the anterolateral thigh （ALT） flap surgery. Methods Between February 2011 and July 2012, 8 patients underwent high frequency color Doppler ultrasound to detect the perforator anatomy before ALT flap surgery. There were 5 males and 3 females, aged 21-46 years （mean, 34 years）. Defects were caused by excision of squamous cell carcinoma in 2 cases, by scalp avulsion in 2 cases, by soft tissue necrosis after neck trauma in 1 case, by excision of groin fibrosarcoma in 1 case, by excision of groin melanoma in 1 case, and by malformation of the face in 1 case. The defect size varied from 12 cm × 7 cm to 22 cm × 18 cm. The perforator with wider caliber, faster flow speed, and shorter intramuscular trajectory was selected, and the flap was designed according to the observed results, which size varied from 14 cm ~ 9 cm to 25 cm ~ 20 cm. The donnor sites were repaired by free skin graft. Results Totally, 19 perforators in the flap area were detected by high frequency color Doppler ultrasound, and 18 were identified during operation, with an accuracy rate of 94.7%. The point going out muscle, the travel and direction of perforators observed during operation were basically in accordance with those detected by high frequency color Doppler ultrasound. The other flaps survived, and obtained healing by first intention except 1 flap which had partial fat necrosis with healing by second intention. The skin graft at donor site survived. All patients followed up 4-16 months （mean, 8 months）. The flaps had good color and texture. Conclusion High frequency color Doppler ultrasound is a valuable imaging modality for the preoperative assessment of the vascular supply for ALT flap.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第2期178-181,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
高频彩色多普勒超声
股前外侧皮瓣
穿支皮瓣
High frequency color Doppler ultrasound Anterolateral thigh flap Perforator flap
