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題 名 | Preoperative Ultrasound Doppler Study and Clinical Correlation of Free Posterior Interosseous Flap=使用術前都卜勒測試來設計執行游離性後骨間動脈皮瓣 |
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作 者 | 鄭明輝; 陳宏基; 陳恆信; 郭耀仁; 魏福全; | 書刊名 | 長庚醫學 |
卷 期 | 20:4 1997.12[民86.12] |
頁 次 | 頁258-264 |
分類號 | 416.413 |
關鍵詞 | 血管解剖學; 後骨間動脈皮瓣; 游離性穿通枝皮瓣; 都卜勒測試; Vascular anatomy; Posterior interosseous flap; Free perforator flap; Ultrasound doppler; |
語 文 | 英文(English) |
中文摘要 | 背景:使用傳統的島狀後骨間動脈板瓣來重建手都軟組織缺損有不低的後遺症, 如部分皮瓣壞死,原因多半由於血管莖曾經受傷或解剖學上的變異。本文主要的目的在於確 認術前都卜勒測試能夠幫助後骨間動脈皮瓣設計,以作為可靠的游離性皮瓣轉移。 方法:從1991到1995年,長庚醫院收集了34病例使用游離性後骨間動脈皮瓣作手部重建, 術前都使用都卜勒測試來確定皮瓣穿通枝的位置、走向及分析解剖學上的變異,來增進游離, 性後骨間動脈皮半的存活率。 結果:結果顯示在全部的游離性後骨間動脈皮瓣中,皮瓣主要穿通枝無論是術前都卜勒測試 或手術中發現都是很穩定及可靠的。皮瓣主要穿通枝源自後骨間動脈有26例(75%),源自 昇骨間迴旋動脈有6例(17.6%),源自總骨間動脈有2例(5.9%)。使用游離性後骨間動脈 的成功率是97%,而且沒有部分皮瓣壞死的合併症。 結論:所以游離性後骨間動脈皮瓣有相當高的成功率,因為它有大的動脈灌流,大且順向的 靜脈回流及可靠的皮瓣穿通枝。如果局部皮瓣特別是以遠端為基底的皮瓣若有不可靠動脈灌 流或靜脈回流時,即可使用術前都卜勒測試,並改變成游離性皮瓣,以避免失敗。此方法也 可用來設計「游離性穿通枝皮瓣」。 |
英文摘要 | Background: Conventional pedicled posterior interosseous flap has a relatively high rate of partial flap loss which may result in ultimate failure to provide coverage of this important structure. The goal of this study was to delineate the posterior interosseous flap as a reliable free tissue transfer. Methods: From 1991 to 1995, 34 patients undergoing free posterior interosseous flap had preoperative Doppler mapping to determine the point of emergence of the skin perforators of the posterior interosseous artery. This finding was correlated intraoperatively with the number of perforators nourishing the posterior interosseous flap. The anatomic variations in the posterior interosseous artery were also identified. Results: These results showed (1) the main skin perforator was consistent and reliable in all of the posterior interosseous flaps both in the preoperative Doppler evaluation and intraoperative findings; (2) the main skin perforator arose from the posterior interosseous artery, the ascending interosseous recurrent artery or the common interosseous artery in 26 cases (76%), 6 cases (17.6%) or 2 cases (5.9%) respectively; (3) the success rate with the use of the free posterior interosseous flap was 97% without any partial flap loss. Conclusion: It is concluded that the free posterior interosseous flap is a reliable flap with adequate arterial flow from constant main skin perforators and large antegrade venous drainage. A less reliable distally based pedicle flap can be changed into a reliable free flap, with the aid of preoperative non-invasive Doppler evaluation. This principle could be applied in the design of other "free skin perforator flaps". |
本系統中英文摘要資訊取自各篇刊載內容。