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題名 | Perforator Branching Patterns and Intertwined Neurovascular Relation in Harvesting Thoracodorsal Artery Perforator Flaps=胸背動脈穿通支皮瓣手術之穿通支分支形態以及神經血管交錯關係 |
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作者 | 林政達; 陳理維; Lin, Cheng-ta; Chen, Lee-wei; |
期刊 | 臺灣整形外科醫學會雜誌 |
出版日期 | 20120300 |
卷期 | 21:1 2012.03[民101.03] |
頁次 | 頁32-39 |
分類號 | 416.413 |
語文 | eng |
關鍵詞 | 胸背動脈; 皮瓣手術; 彩色都譜樂; 交錯關係; Thoracodorsal artery; Color doppler; Intertwined; |
中文摘要 | 背景:胸背動脈穿通支皮瓣手術中,血管莖以及運動神經之關係緊密。此種情形下,會造成這二種結構於皮瓣摘取過程中,易遭受到傷害。在過去,有關於穿通支及運動神經之間的詳細解剖關係也未曾被提及。目的及目標:定義胸背動脈穿通支的分支種類,以及穿通支和胸背神經的解剖關係。材料及方法:我們針對五十二個,接受胸背動脈穿通支皮瓣手術來重建各種軟組織缺損的東方人病患,進行其彩色都譜樂超音波掃描以及手術中解剖發現的回顧性分析。穿通支的分支種類,以及穿通支和胸背神經之間的“交錯關係”也被定義。結果:七個病患有單穿通,四十五個病患有多穿通支。於多穿通支組,十二個病患有type-A分支,十九個有type-B分支,十個有type-C分支,四個有type-D分支。交錯關係出現於共二十一位病患,出現機率於type-A病患為百分之三十三點三, type-B病患為百分之三十六點八,type-C病患為百分之七十,type-D病息為百分之七十五。於七個病人,為了將穿通支解放出來,而將胸背神經截斷,於皮瓣摘取完成後再行接合。一位病患發現有主觀性的肩膀活動力減弱。結論:這些發現有助於我們了解,在胸背動脈穿通支皮瓣手術中,神經血管的交纏結構,以及可能對胸背神經產生傷害之危險。於大部份的病患,胸背神經可被保留下來。但是為了將穿通支解放出來,可能會需要神經截斷,於皮瓣摘取完成後,再行接合。 |
英文摘要 | Background:The close relationship between the vascular pedicle and motor nerve may cause injury to both structures during the harvest of the thoracodorsal artery perforator flap. However, detailed anatomic relations between the perforators and motor nerves were not described in the past.Aim and Objectives:To define the branching patterns of thoracodorsal artery perforators and the anatomic relation between the perforators and thoracodorsal nerves.Materials and Methods:We retrospectively reviewed the results of preoperative color Doppler sonography and intraoperative findings in fifty-two patients who underwent thoracodorsal artery perforator flap reconstructions of various soft-tissue defects. The branching patterns were identified, and the ”intertwined relation” between the thoracodorsal nerve and perforators was defined.Results:There were seven and forty-five patients with single perforator and multiple perforators respectively. In the multiple-perforators group, twelve patients had type-A branching pattern, nineteen had type-B pattern, ten had type-C pattern, and four had type-D pattern. The intertwined relation appeared in twenty-one patients. The incidence of intertwined relation was 33.3 percent in the patients of type-A branching pattern, 36.8 percent in the patients of type-B pattern, 70.0 percent in the patients of type-C pattern, and 75.0 percent in patients of type-D pattern. One patient sustained total flap loss, and two patients experienced distal flap necrosis. The thoracodorsal nerve was severed to deliver the perforators and repaired after flap harvest in seven patients. Subjective weakness of shoulder motion was noted in one patient.Conclusions:The findings help us appreciate the tangled neurovascular anatomy and the possible risks of injury to motor nerve in the harvests of thoracodorsal artery perforator flaps. The thoracodorsal nerves can be preserved in most cases. However, they may require severance to deliver the perforators and repair after flap harvest. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。