课件：侯春林教授主题带血管蒂的组织瓣移位术解剖与设计原则正.ppt

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,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 vascular pedicle is a surgical skill to reconstruct adjacent tissue defect. The pedicels of these flaps are their nutritional blood vessels.,前 言 foreword,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 be reconstructed by transferring of vascular pedicle flaps.,前 言 foreword,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 safe. It has being applied in every surgical field.,前 言 foreword,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.,Blood supply of skin,直接皮动脉 direct cutaneous artery,肌皮动脉 musculocutaneous artery,Blood supply of muscle,Blood supply of muscle,Blood supply of fascia profunda,筋膜上血管丛 Vascular plexus up-fascia,筋膜下血管丛Vascular plexus sub-fascia,筋膜 Fascia,皮肤 Skin,肌肉 Muscle,肌皮穿支动脉 Ramus of musculocutaneous artery,肌间隙血管 Vessel between muscles,皮 瓣 类 型 Classification of skin flaps,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 flap,筋 膜 皮 瓣 Fasciocutaneous flap,筋膜皮瓣 Fasciocutaneous flap,皮肤 Skin,皮下组织 Subcutaneus tissue,肌肉 muscle,深筋膜 fascia profunda,筋膜皮瓣 Fasciocutaneous flap,翻 转 筋 膜 瓣 Reversal fasciocutaneous flap,轴 型 皮 瓣 Axial flap,轴型皮瓣 Axial flap,肌间隙血管 Vessel between muscles,皮肤 Skin,皮下组织 Subcutaneus tissue,深筋膜 fascia profunda,肌肉 muscle,轴型皮瓣 Axial flap,肌 皮 瓣 Musculocutaneous flap,肌肉皮肤蒂肌皮瓣 Musculocutaneous flap with musculocutaneous pedicle,肌肉皮下组织蒂肌皮瓣 Musculocutaneous flap with musculosubcutaneous pedicle,肌肉蒂肌皮瓣 Musculocutaneous flap with muscle pedicle,血管神经蒂岛状肌皮瓣 Musculocutaneous island flap with vasonerval pedicle,肌皮瓣 musculocutaneous flap,皮瓣设计 Design of the flap,点 旋转轴 Pointaxis to transfer flaps,线 轴心线 Line axal line of the flap,面 血供范围 Rangeextent to which the nutritional vessel can supply,弧 旋转弧 Arcboundary that the flap can reach,Axis and arc of flap,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 methods 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 malformation rectification,手术指征 Indication,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 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. 感觉、运动功能重建及某些器官再造 Wounds repair with simultaneous reconstruction of motor or nerve function.,手术指征 Indication,对供区功能、外观影响较小 The flap with less affect to donor site. 血管恒定、变异少，易于切取 The flap acquired easily and with less variable vessles 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, quality and function .,皮瓣选择 Selection of flap,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 site,足底皮瓣 Plantar flap of foot 足背皮瓣 Dorsal flap of foot 小腿皮瓣 Crural flap,足跟创面 calcaneal defect,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 muscle 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 character,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 site,N. Digitales dorsales,N. Digitales palmares proprii,A. Digitales palmares proprii,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 considered. The size of flap should exceed that of the defect.,手 术 要 点 Operation outline,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,先标明旋转中心位置及皮瓣纵轴线，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,a,d,o,b,c,上部臀大肌肌皮瓣修复骶部褥疮 Repair the sacrum bedsore using the myocutaneous superior of Muscle gluteus maximus,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. 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 manners,Classical manner,Reverse manner,顺行切取 Classical manner,逆行切取 Reverse manner,皮瓣移位 Shift 皮瓣推进 Advancement 皮瓣旋转 Rotation 交叉移植 crossing,皮瓣转移 Flap transfer,皮 瓣 移 位 Shift of flap,皮 瓣 推 进 Advancement of flap,A,B,C,D,皮 瓣 旋 转 Rotation of flap,交 叉 移 植 Cross transplant,注 意 事 项 Notes,选用正常部位皮肤和肌肉作为供区 Choose the normal skin and muscle as donor tissue. 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.,注 意 事 项 Notes,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