帶血管蒂的組織瓣移位術(shù)解剖與設(shè)計(jì)原則正參考PPT

1、1,第二軍醫(yī)大學(xué)長征醫(yī)院骨科 Department of Orthopaedic Surgery, Changzheng Hospital, Shanghai 侯 春 林 HOU Chun-lin,帶血管蒂組織瓣移位術(shù)解剖與基本原則 Anatomy of vascular pedicle flaps and principle of the operation,2,帶血管組織瓣移位術(shù)是以組織瓣的營養(yǎng)血管為蒂，通過局部轉(zhuǎn)移來修復(fù)臨近組織缺損 。 The transfer of cutaneous, myocutaneous and muscle flaps with vascular pedic

2、le is a surgical skill to reconstruct adjacent tissue defect. The pedicels of these flaps are their nutritional blood vessels,前 言 foreword,3,由于幾乎全身所有部位皮膚均可形成皮瓣、肌皮瓣，這就使全身任何部位創(chuàng)面均可采用帶血管蒂組織瓣移位術(shù)治療。 The flap can be acquired from every anatomic region of the body. So this make all defects can be reconstruc

3、ted by transferring of vascular pedicle flaps,前 言 foreword,4,與吻合血管的游離組織移植相比，此項(xiàng)技術(shù)不需吻合血管，方法簡(jiǎn)便、安全、成功率高， 現(xiàn)已用于外科各個(gè)領(lǐng)域。 Contrasting with dissociative tissue flaps, it is not required to connect vessels by anastomosis in transfer of flaps with vascular pedicle. This technic is simple and safe. It has being

4、applied in every surgical field,前 言 foreword,5,帶血管蒂的皮瓣、?。ㄆぃ┌贽D(zhuǎn)移術(shù)是把帶有血管蒂的皮瓣、?。ㄆぃ┌?，通過局部轉(zhuǎn)移的方法，來修復(fù)鄰近組織缺損 The transfer of cutaneous, myocutaneous and muscle flaps with vascular pedicle is a surgical skill to reconstruct adjacent tissue defect by local displacement,6,Blood supply of skin,7,直接皮動(dòng)脈 direct cut

5、aneous artery,8,肌皮動(dòng)脈 musculocutaneous artery,9,Blood supply of muscle,10,Blood supply of muscle,11,Blood supply of fascia profunda,12,筋膜上血管叢 Vascular plexus up-fascia,筋膜下血管叢Vascular plexus sub-fascia,筋膜 Fascia,皮膚 Skin,肌肉 Muscle,肌皮穿支動(dòng)脈 Ramus of musculocutaneous artery,肌間隙血管 Vessel between muscles,13,

6、皮 瓣 類 型Classification of skin flaps,隨意皮瓣 Random flap 筋膜皮瓣與筋膜瓣 Fasciocutaneous flap and fascia flap 軸形皮瓣 Axial flap 肌皮瓣與肌瓣 musculocutaneous flap and muscle flap,14,筋 膜 皮 瓣 Fasciocutaneous flap,15,筋膜皮瓣 Fasciocutaneous flap,皮膚 Skin,皮下組織 Subcutaneus tissue,肌肉 muscle,深筋膜 fascia profunda,16,筋膜皮瓣 Fasciocut

7、aneous flap,17,翻 轉(zhuǎn) 筋 膜 瓣 Reversal fasciocutaneous flap,18,19,軸 型 皮 瓣 Axial flap,20,軸型皮瓣 Axial flap,肌間隙血管 Vessel between muscles,皮膚 Skin,皮下組織 Subcutaneus tissue,深筋膜 fascia profunda,肌肉 muscle,21,22,23,軸型皮瓣 Axial flap,24,肌 皮 瓣 Musculocutaneous flap,25,26,27,28,肌肉皮膚蒂肌皮瓣 Musculocutaneous flap with muscul

8、ocutaneous pedicle,29,肌肉皮下組織蒂肌皮瓣 Musculocutaneous flap with musculosubcutaneous pedicle,30,肌肉蒂肌皮瓣 Musculocutaneous flap with muscle pedicle,31,血管神經(jīng)蒂島狀肌皮瓣 Musculocutaneous island flap with vasonerval pedicle,32,33,34,肌皮瓣 musculocutaneous flap,35,皮瓣設(shè)計(jì) Design of the flap,點(diǎn) 旋轉(zhuǎn)軸 Pointaxis to transfer fla

9、ps,線 軸心線 Line axal line of the flap,面 血供范圍 Rangeextent to which the nutritional vessel can supply,弧 旋轉(zhuǎn)弧 Arcboundary that the flap can reach,36,Axis and arc of flap,37,創(chuàng)傷、潰瘍、腫瘤切除所致軟組織缺損 Soft tissue defect of any causes that could not be reconstructed through conventional methods 四肢瘢痕攣縮畸形，切除瘢痕、矯正畸形有深部

10、組織裸露 Malformation caused by scar crispation, bare deep tissues caused by scar excision and malformation rectification,手術(shù)指征 Indication,38,需在瘢痕或竇道區(qū)進(jìn)行骨、關(guān)節(jié)、 肌腱手術(shù)者 Operations on bone, joint or tendons in regions of scars and sinuses 慢性骨髓炎病灶清除后有創(chuàng)面裸露 Cavities of Supercilious ulcer, purulent osteomyelitis a

11、nd bedsore that need to be cleaned up in phade 1 after thorough treatment. 感覺、運(yùn)動(dòng)功能重建及某些器官再造 Wounds repair with simultaneous reconstruction of motor or nerve function,手術(shù)指征 Indication,39,對(duì)供區(qū)功能、外觀影響較小 The flap with less affect to donor site. 血管恒定、變異少，易于切取 The flap acquired easily and with less variable

12、 vessles 根據(jù)受區(qū)部位、大小、創(chuàng)面性質(zhì)及 功能要求選擇皮瓣 The flap suit for recipient site in position, size, quality and function,皮瓣選擇 Selection of flap,40,鄰近創(chuàng)面的皮瓣，質(zhì)地近似，轉(zhuǎn)移方便，應(yīng)優(yōu)先選用 The preferable flap with the character of adjacent to the recipient site, having similar texture and thickness and easily transferred,根據(jù)受區(qū)部位選擇皮

13、瓣 Selection of flap according to recipient site,41,足底皮瓣 Plantar flap of foot 足背皮瓣 Dorsal flap of foot 小腿皮瓣 Crural flap,足跟創(chuàng)面 calcaneal defect,42,無骨和肌肉缺損的創(chuàng)面，選用軸型皮瓣 The axial flap suitable for wound without defect of bone and muscle 有骨或肌肉缺損的創(chuàng)面選用肌皮瓣較好 The musculocutaneous flap suitable for wound with de

14、fect of bone and muscle,根據(jù)創(chuàng)面性質(zhì)選擇皮瓣 Selection of flap according to defect character,43,44,45,需同時(shí)恢復(fù)缺損區(qū)感覺功能時(shí)，應(yīng)選用含感覺神經(jīng)的皮瓣；需同時(shí)重建缺損區(qū)肌肉功能時(shí)，應(yīng)選用帶運(yùn)動(dòng)神經(jīng)的肌皮瓣。 If the function of movement or sense is required, the flap should be composed with the muscle or sense nerve,根據(jù)受區(qū)功能要求選擇皮瓣 Selection of flap according to f

15、unction requirement of recipient site,46,47,N. Digitales dorsales,N. Digitales palmares proprii,A. Digitales palmares proprii,48,根據(jù)創(chuàng)面大小選擇皮瓣 Selection of flap according to the size of defect,皮瓣選擇應(yīng)考慮到受區(qū)范圍及皮瓣可能提供的大小，皮瓣應(yīng)稍大于受區(qū)創(chuàng)面 The size of defect and flap should be considered. The size of flap should ex

16、ceed that of the defect,49,50,手 術(shù) 要 點(diǎn) Operation outline,51,慢性感染創(chuàng)面需徹底病灶清除 The sinus, dead bone, inflammatory tissue with poor blood supply must be thoroughly cleaned up,受區(qū)準(zhǔn)備 Preparation of the recipient site,52,先標(biāo)明旋轉(zhuǎn)中心位置及皮瓣縱軸線，根據(jù)創(chuàng)面形狀及大小設(shè)計(jì)皮瓣 First, make sure the position of the vascular pedicle and th

17、e nutritional vessel of the flap, then mark it on the skin.Design the flap according to the shape and size of the defect,皮瓣設(shè)計(jì) Design of the flap,53,a,d,o,b,c,54,上部臀大肌肌皮瓣修復(fù)骶部褥瘡 Repair the sacrum bedsore using the myocutaneous superior of Muscle gluteus maximus,55,順行切取 先顯露血管蒂部,由近向遠(yuǎn)分離皮瓣 First, expose t

18、he vascular pedicle, and then cut off the flap along the boundary of the flap. 逆行切取 從皮瓣遠(yuǎn)端開始,由遠(yuǎn)向近切取皮瓣 First, cut off the flap, and then dissociate the vascular pedicle,皮瓣切取 operation manners,Classical manner,Reverse manner,56,順行切取 Classical manner,逆行切取 Reverse manner,57,皮瓣移位 Shift 皮瓣推進(jìn) Advancement 皮瓣旋轉(zhuǎn) Rotation 交叉移植 crossing,皮瓣轉(zhuǎn)移 Flap transfer,58,皮 瓣 移 位 Shift of flap,59,60,61,皮 瓣 推 進(jìn) Advancement of flap,62,A,B,C,D,63,64,65,66,皮 瓣 旋 轉(zhuǎn) Rotation of flap,67,68,69,70,71,交 叉 移 植 Cross transplant,72,73,74,注 意 事 項(xiàng) Notes,選用正常