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1、Changzheng第二军医大学长征医院骨科 Department of Orthopaedic Surgery,Changzheng Hospital,Shanghai 侯 春 林HOU Chun-lin 带血管蒂组织瓣移位术解剖与基本原则Anatomy of vascular pedicle flaps and principle of the operation Changzheng带血管组织瓣移位术是以组织瓣的营养血管为蒂，通过局部转移来修复临近组织缺损。The transfer of cutaneous,myocutaneous and muscle flaps with vascu
2、lar pedicle is a surgical skill to reconstruct adjacent tissue defect.The pedicels of these flaps are their nutritional blood vessels.前 言 forewordChangzheng由于几乎全身所有部位皮肤均可形成皮瓣、肌皮瓣，这就使全身任何部位创面均可采用带血管蒂组织瓣移位术治疗。The flap can be acquired from every anatomic region of the body.So this make all defects can
3、be reconstructed by transferring of vascular pedicle flaps.前 言 forewordChangzheng与吻合血管的游离组织移植相比，此项技术不需吻合血管，方法简便、安全、成功率高，现已用于外科各个领域。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 saf
4、e.It has being applied in every surgical field.前 言 forewordChangzheng带血管蒂的皮瓣、肌（皮）瓣转移术是把带有血管蒂的皮瓣、肌（皮）瓣，通过局部转移的方法，来修复邻近组织缺损The transfer of cutaneous,myocutaneous and muscle flaps with vascular pedicle is a surgical skill to reconstruct adjacent tissue defect by local displacement.ChangzhengBlood suppl
5、y of skinChangzheng直接皮动脉 direct cutaneous arteryChangzheng肌皮动脉 musculocutaneous arteryChangzhengBlood supply of muscleChangzhengBlood supply of muscleChangzhengBlood supply of fascia profundaChangzheng筋膜上血管丛 筋膜上血管丛Vascular plexus up-fascia筋膜下血管丛 筋膜下血管丛Vascular plexus sub-fascia筋膜 筋膜 Fascia皮肤 皮肤 Skin
6、肌肉 肌肉 Muscle 肌皮穿支动脉 肌皮穿支动脉Ramus of musculocutaneous artery肌间隙血管 肌间隙血管 Vessel between musclesChangzheng皮皮 瓣瓣 类类 型型Classification of skin Classification of skin flapsflaps 随意皮瓣 Random flap 筋膜皮瓣与筋膜瓣 Fasciocutaneous flap and fascia flap 轴形皮瓣 Axial flap 肌皮瓣与肌瓣 musculocutaneous flap and muscle flapChangzh
7、eng筋筋 膜膜 皮皮 瓣瓣 FasciocutaneousFasciocutaneous flap flapChangzheng筋膜皮瓣筋膜皮瓣 Fasciocutaneous Fasciocutaneous flap flap皮肤 皮肤 Skin皮下组织 皮下组织 Subcutaneus tissue肌肉 肌肉 muscle 深筋膜 深筋膜 fascia profundaChangzheng筋膜皮瓣筋膜皮瓣 Fasciocutaneous Fasciocutaneous flap flapChangzheng翻翻 转转 筋筋 膜膜 瓣瓣ReversalReversal fasciocuta
8、neous fasciocutaneous flap flapChangzhengChangzheng轴轴 型型 皮皮 瓣瓣Axial flapAxial flapChangzheng轴型皮瓣轴型皮瓣 Axial flap Axial flap肌间隙血管 肌间隙血管Vessel between muscles皮肤 皮肤 Skin皮下组织 皮下组织 Subcutaneus tissue深筋膜 深筋膜 fascia profunda肌肉 肌肉 muscleChangzhengChangzhengChangzheng轴型皮瓣 Axial flapChangzheng肌肌 皮皮 瓣瓣Musculocu
9、taneousMusculocutaneous flap flapChangzhengChangzhengChangzhengChangzheng肌肉皮肤蒂肌皮瓣肌肉皮肤蒂肌皮瓣Musculocutaneous flap with musculocutaneous pedicleChangzheng肌肉皮下组织蒂肌皮瓣肌肉皮下组织蒂肌皮瓣Musculocutaneous flap with musculosubcutaneous pedicleChangzheng肌肉蒂肌皮瓣肌肉蒂肌皮瓣 Musculocutaneous flap with muscle pedicle Changzheng血
10、管神经蒂岛状肌皮瓣血管神经蒂岛状肌皮瓣Musculocutaneous island flap with vasonerval pedicleChangzhengChangzhengChangzheng肌皮瓣musculocutaneous flapChangzheng皮瓣设计Design of the flap 点 旋转轴Point axis to transfer flaps 线 轴心线 Line axal line of the flap面 血供范围 Range extent to which the nutritional vessel can supply弧 旋转弧 Arc boun
11、dary that the flap can reachChangzheng Axis and arc of flapChangzhengv 创伤、溃疡、肿瘤切除所致软组织缺损 Soft tissue defect of any causes that could not be reconstructed through conventional methodsv 四肢瘢痕挛缩畸形，切除瘢痕、矫正畸形有深部组织裸露 Malformation caused by scar crispation,bare deep tissues caused by scar excision and malfo
12、rmation rectification手术指征 IndicationChangzhengv需在瘢痕或窦道区进行骨、关节、肌腱手术者 Operations on bone,joint or tendons in regions of scars and sinuses v慢性骨髓炎病灶清除后有创面裸露 Cavities of Supercilious ulcer,purulent osteomyelitis and bedsore that need to be cleaned up in phade 1 after thorough treatment.v感觉、运动功能重建及某些器官再造
13、Wounds repair with simultaneous reconstruction of motor or nerve function.手术指征 IndicationChangzhengv对供区功能、外观影响较小 The flap with less affect to donor site.v血管恒定、变异少，易于切取 The flap acquired easily and with less variable vessles v根据受区部位、大小、创面性质及 功能要求选择皮瓣 The flap suit for recipient site in position,size,
14、quality and function.皮瓣选择 Selection of flapChangzhengv邻近创面的皮瓣，质地近似，转移方便，应优先选用 The preferable flap with the character of adjacent to the recipient site,having similar texture and thickness and easily transferred根据受区部位选择皮瓣 Selection of flap according to recipient siteChangzheng足底皮瓣Plantar flap of foot
15、 足背皮瓣Dorsal flap of foot 小腿皮瓣Crural flap足跟创面calcaneal defectChangzhengv无骨和肌肉缺损的创面，选用轴型皮瓣 The axial flap suitable for wound without defect of bone and musclev有骨或肌肉缺损的创面选用肌皮瓣较好 The musculocutaneous flap suitable for wound with defect of bone and muscle根据创面性质选择皮瓣 Selection of flap according to defect c
16、haracter ChangzhengChangzhengChangzhengv需同时恢复缺损区感觉功能时，应选用含感觉神经的皮瓣；需同时重建缺损区肌肉功能时，应选用带运动神经的肌皮瓣。If the function of movement or sense is required,the flap should be composed with the muscle or sense nerve.根据受区功能要求选择皮瓣 Selection of flap according to function requirement of recipient siteChangzhengChangzh
17、engN.N.Digitales dorsales Digitales dorsalesN.N.Digitales palmares proprii Digitales palmares propriiA.A.Digitales Digitalespalmares proprii palmares propriiChangzheng根据创面大小选择皮瓣Selection of flap according to the size of defect皮瓣选择应考虑到受区范围及皮瓣可能提供的大小，皮瓣应稍大于受区创面The size of defect and flap should be con
18、sidered.The size of flap should exceed that of the defect.ChangzhengChangzheng手手 术术 要要 点点 Operation outlineOperation outlineChangzhengv慢性感染创面需彻底病灶清除 The sinus,dead bone,inflammatory tissue with poor blood supply must be thoroughly cleaned up.受区准备Preparation of the recipient site Changzhengv先标明旋转中心位置
19、及皮瓣纵轴线，根据创面形状及大小设计皮瓣 First,make sure the position of the vascular pedicle and the nutritional vessel of the flap,then mark it on the skin.Design the flap according to the shape and size of the defect.皮瓣设计 Design of the flap Changzhenga ad do ob bc cChangzheng上部臀大肌肌皮瓣修复骶部褥疮 Repair the sacrum bedsore
20、using the myocutaneous superior of Muscle gluteus maximusChangzhengv顺行切取 先显露血管蒂部,由近向远分离皮瓣 First,expose the vascular pedicle,and then cut off the flap along the boundary of the flap.v逆行切取 从皮瓣远端开始,由远向近切取皮瓣 First,cut off the flap,and then dissociate the vascular pedicle.皮瓣切取 operation mannersClassical
21、mannerReverse mannerChangzheng顺行切取顺行切取Classical manner逆行切取逆行切取Reverse mannerChangzhengv皮瓣移位 Shiftv皮瓣推进 Advancementv皮瓣旋转 Rotationv交叉移植 crossing皮瓣转移 Flap transferChangzheng皮皮 瓣瓣 移移 位位Shift of flapShift of flapChangzhengChangzhengChangzheng皮皮 瓣瓣 推推 进进Advancement of flapAdvancement of flapChangzhengA A
22、B B C C D DChangzhengChangzhengChangzhengChangzheng皮皮 瓣瓣 旋旋 转转Rotation Rotation of flapof flapChangzhengChangzhengChangzhengChangzhengChangzheng交交 叉叉 移移 植植Cross transplantCross transplantChangzhengChangzhengChangzheng注注 意意 事事 项项 NoteNotess 选用正常部位皮肤和肌肉作为供区 Choose the normal skin and muscle as donor t
23、issue.彻底切除疤痕组织，注意无张力缝合 The sinus,dead bone,inflammatory tissue with poor blood supply must be thoroughly cleaned.严格按解剖层次切取皮瓣，防止血管 与皮瓣，肌肉与皮肤分离 Cut the flap according to the anatomical arrangement to avoid vessel separation from the flap,and muscle from the skin.Changzheng注注 意意 事事 项项 NotesNotes 切取肌皮瓣，若皮肤范围超过肌肉范 围时，应包括完整深筋膜 If the myocutaneous flap is needed,and the skin scope exceeds that of the muscle,the fascia profunda should be reserved completely.皮瓣转移时，应防止血管蒂卷曲、扭 转和受压 During the operation,vascular pedicle should not be curled,pressed and retorted.Changzheng谢谢大家Thank You!