二纵三横法在胸背动脉穿支皮瓣穿支定位及深度创面修复中的临床应用效果

黄广涛; 魏在荣; 黄丽; 李书俊; 陈伟; 杨成兰; 聂开瑜; 邓呈亮; 王达利

doi:10.3760/cma.j.cn501120-20201207-00519

二纵三横法在胸背动脉穿支皮瓣穿支定位及深度创面修复中的临床应用效果

doi: 10.3760/cma.j.cn501120-20201207-00519

遵义医科大学附属医院烧伤整形外科，遵义　　563003

基金项目:

贵州省科技计划 2020-5012, 2019-4441

省部共建协同创新中心项目 2020-39

详细信息

通讯作者:
魏在荣，Email：188116999@qq.com

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出版历程
- 收稿日期: 2020-12-07

Clinical application effects of two longitudes three transverses method in perforator location of thoracodorsal artery perforator flap and deep wound repair

Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China

Funds:

Science and Technology Project of Guizhou Province of China 2020-5012, 2019-4441

Collaborative Innovation Center of Chinese Ministry of Education and Guizhou Province 2020-39

More Information

Corresponding author: Wei Zairong, Email: 188116999@qq.com

摘要

摘要: 目的探讨二纵三横法在胸背动脉穿支皮瓣穿支定位及深度创面修复中的临床应用价值。方法采用回顾性观察性研究方法。2018年12月—2020年6月，遵义医科大学附属医院收治17例符合入选标准的深度创面患者，其中男7例、女10例，年龄12~72岁。清创后创面面积为7 cm×3 cm~11 cm×7 cm。通过腋窝中点、髂后上棘和骶髂关节突出点定位2条纵线，在2条纵线间通过腋窝中点下5、10、15 cm定位3条横线（即二纵三横法），从而形成2个梯形区域，再使用便携式多普勒血流探测仪在2个梯形区域内探寻胸背动脉穿支，以此设计并切取单个、分叶或携带部分背阔肌的面积为7 cm×4 cm~12 cm×8 cm的游离胸背动脉穿支皮瓣修复创面。供区均直接缝合。记录术前定位与术中探查胸背动脉穿支数量、位置及第1穿支（距离腋窝顶点最近的穿支）穿出肌肉的位置距离背阔肌外侧缘的长度，术中测量的胸背动脉穿支管径，采用的组织瓣类型；术后随访组织瓣成活情况与供区外观。结果每例患者术前定位胸背动脉穿支数量、位置与术中探查情况一致，穿支数量为2条或3条（共42条）；穿支均位于2个梯形区域内，在第1个梯形区域中均定位和探查到1条稳定的穿支（第1穿支），第2个梯形区域的平均穿支数量为1.47条；第1穿支穿出肌肉的位置距离背阔肌外侧缘2.1~3.1 cm。术中测量的胸背动脉穿支管径为0.4~0.6 mm。本组患者中12例采用单个胸背动脉穿支皮瓣、3例采用胸背动脉穿支分叶皮瓣、2例采用携带部分背阔肌的胸背动脉穿支皮瓣。术后随访6~16个月，17例患者组织瓣均成活，质地柔软、弹性好、血运良好；供区仅遗留线性瘢痕。结论二纵三横法有助于胸背动脉穿支皮瓣的穿支定位，方法简单可靠，基于该方法设计切取的胸背动脉穿支皮瓣修复深度创面的临床效果良好，供区损伤小。
- 创伤和损伤 /
- 外科皮瓣 /
- 胸背动脉穿支皮瓣 /
- 二纵三横法 /
- 背阔肌
Abstract: Objective To explore the clinical application value of two longitudes three transverses method in the location of the perforator of thoracodorsal artery perforator and deep wound repair. Methods The retrospectively observational study was conducted. From December 2018 to June 2020, 17 patients with deep wounds who were admitted to the Affiliated Hospital of Zunyi Medical University met the inclusion criteria and were included in this study, including 7 males and 10 females, aged 12 to 72 years. The wound areas of patients after debridement were 7 cm×3 cm to 11 cm×7 cm. Two longitudinal lines were located through the midpoint of the armpit, the posterior superior iliac spine, and the protruding point of the sacroiliac joint, and three transverse lines were located 5, 10, and 15 cm below the midpoint of the armpit between the two longitudinal lines, i.e. two longitudes three transverses method, resulting in two trapezoidal areas. And then the thoracodorsal artery perforators in two trapezoidal areas were explored by the portable Doppler blood flow detector. On this account, a single or lobulated free thoracodorsal artery perforator flap or flap that carrying partial latissimus dorsi muscle, with an area of 7 cm×4 cm to 12 cm×8 cm was designed and harvested to repair the wound. The donor sites were all closed by suturing directly. The number and location of thoracodorsal artery perforators, and the distance from the position where the first perforator (the perforator closest to the axillary apex) exits the muscle to the lateral border of the latissimus dorsi in preoperative localization and intraoperative exploration, the diameter of thoracodorsal artery perforator measured during operation, and the flap types were recorded. The survivals of flaps and appearances of donor sites were followed up. Results The number and location of thoracodorsal artery perforators located before operation in each patient were consistent with the results of intraoperative exploration. A total of 42 perforators were found in two trapezoidal areas, with 2 or 3 perforators each patient. The perforators were all located in two trapezoid areas, and a stable perforator (the first perforator) was located and detected in the first trapezoidal area. There were averagely 1.47 perforators in the second trapezoidal area. The position where the first perforator exits the muscle was 2.1-3.1 cm away from the lateral border of the latissimus dorsi. The diameters of thoracodorsal artery perforators were 0.4-0.6 mm. In this group, 12 cases were repaired with single thoracodorsal artery perforator flap, 3 cases with lobulated thoracodorsal artery perforator flap, and 2 cases with thoracodorsal artery perforator flap carrying partial latissimus dorsi muscle. The patients were followed up for 6 to 16 months. All the 17 flaps survived with good elasticity, blood circulation, and soft texture. Only linear scar was left in the donor area. Conclusions The two longitudes three transverses method is helpful to locate the perforator of thoracodorsal artery perforator flap. The method is simple and reliable. The thoracodorsal artery perforator flap designed and harvested based on this method has good clinical effects in repairing deep wound, with minimal donor site damage.
- Wounds and injuries /
- Surgical flaps /
- Thoracodorsal artery perforator flap /
- Two longitudes three transverses method /
- Latissimus dorsi muscle
黄广涛：数据采集、文章撰写；魏在荣、聂开瑜、邓呈亮、王达利：研究指导、获取研究经费、论文修改；黄丽、李书俊：数据采集；陈伟、杨成兰：数据整理、数据分析

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1 二纵三横法画线及便携式多普勒血流探测仪定位的胸背动脉穿支

注：x1、x2分别为连接腋窝中点和髂后上棘突出点、腋窝中点和骶髂关节突出点形成的2条纵线，y1、y2、y3分别为连接x1和x2线上距离腋窝中点5、10、15 cm的点形成的3条横线，梯形Ⅰ和梯形Ⅱ为由2条纵线与3条横线围成的2个区域，红圈为定位的穿支位置

下载: 全尺寸图片幻灯片

2 携带部分背阔肌的游离胸背动脉穿支皮瓣修复1例患者左足深度创面。2A.术前创面见第4跖骨远端缺失，部分骨质和肌腱外露；2B.术中切取可见皮瓣穿支（蓝线）及胸背神经（橡皮片），胸背神经走行于穿支前内侧；2C.完整切取携带部分背阔肌的游离胸背动脉穿支皮瓣；2D.术后即刻效果；2E、2F.分别为术后半年术区、供区随访情况，皮瓣存活良好，供区仅遗留线性瘢痕

下载: 全尺寸图片幻灯片