成人旋髂深动脉穿支皮瓣嵌合髂骨瓣的应用解剖与临床分析.docx

行修复的骨缺损合并皮肤软组织缺损的病例，并设其为对照组；设研究组为 2008年3月至2011年6月期间，应用旋骼深动脉穿支皮瓣嵌合的骼骨瓣修复 的20例骨缺损合并皮肤软组织缺损的病例。分别比较两组病例骨瓣的愈合时 间、皮 瓣坏死和臃肿的发生率，观察旋骼深动脉穿支皮瓣嵌合骼骨瓣的临床疗 效。 纟吉果 对照组：术后皮瓣7例出现不同程度坏死：1例完全坏死，予另 设计股前外侧皮瓣修复愈合；1例部分坏死，2例边缘坏死，3例表皮坏死， 通过扩 创或植皮后愈合。皮瓣中有7例外观较臃肿，4例稍臃肿。研究组： 术后20例皮瓣全部存活，其中19例完全愈合，仅1例皮瓣边缘表皮部分皮 肤坏死，换药后愈合。3例皮瓣稍臃肿，外观较满意。供区均直接缝合，仅留 线性疤痕。术后随访 见两组骨瓣愈合时间无差异(P0. 05),研究组皮瓣坏死 (5%)和臃肿发生率(15%)发生率较对照组(35%和55%)低，存在统计学意义 (P0. 05) o 纟吉论旋骼深动脉穿支皮瓣嵌合骼骨瓣具有临床可行性，骨瓣和皮瓣适 度分离更有利于临床应用，可降低术后皮瓣坏死风险，同时减少了对供区损 伤，皮瓣无明显臃肿，增加了皮瓣美观，是临床修复骨缺损并皮肤软组织的有 效方法之一。 关键词骨缺损；嵌合皮瓣；显微外科 Abstract Chapter I Applied Anatomic Study of the adult chimericosteocutaneous perforator flap with deep iliac circumflex artery Objective To provide anatomic evidence for the application of the deep circumflex iliac artery perforator flap by approaching the course, branches, number, area, lengths and the external diameters of cutaneous branches based on the deep circumflex iliac artery perforator flap. Methods Choose 10 fresh Chinese adult cadavers were perfused with red latex and performed micro-anatomy to observe the number of perforators based on the deep circumflex iliac artery perforator flap in 20 sides, and their branches distribution,external diameters, the pedicle lengths, the pedicle widths, and the distribution area of the perforating point based on the deep circumflex iliac artery perforator flap. One side of the specimen was simulated the operation of the chimeric osteocutaneous perforator flap with deep iliac circumflex artery. The data were analyzed with SPSS 13.0 statistical software. Results The deep iliac circumflex artery could be divided into three segments accoding to its route : the inguinal one , the iliac spinal one and the superior iliac spinal one . The superior iliac spinal segment developed into a myocutaneous artery, perforating through the deep fascia to dominate the skin.Totally 22 perforator flaps were found in 20 side of 10 cadavers(on average 1.1). The external diameter of the deep iliac circumflex vessel p