穿支蒂皮瓣vs穿支筋膜蒂皮瓣.pptVIP

模型 直径1mm 长30mm 腔内充盈液体 扭转角度对静脉的影响更大 超过180，应变急剧变化，说明静脉闭塞 动脉在360仍通畅 静脉 动脉 血管长度超过3cm时，应力急剧下降 血管直径1mm，应力最小 文献2：动物实验 大鼠实验 cranial epigastric artery true perforator flaps，on a single perforator 不切断血管，仅进行血管蒂的旋转 扭转超过180°，皮瓣成活面积急剧下降 文献3：临床 2010年Schaverien，106例胫后动脉穿支蒂岛状皮瓣，均螺旋桨样， 其中72%修复小腿下1/3、10%修复足部和踝部，88%的创面与骨折有关，60%有胫骨髓内钉；皮瓣平均旋转角度160°（60 °－180 °） 结果8.5%皮瓣完全坏死，12%皮瓣部分坏死。 切取技巧 先前后切开，深筋膜下掀起 保留所有的穿支 远－近皮桥完整 阻断近侧皮桥，阻断其他穿支 观察血循 文献4：临床 Soft tissue defect over the medial malleolus and damaged Achilles tendon. Exploratory incision in search of a perforator preoperatively localised by Doppler. The perforator vessel nourishing the flap. Pivot point of the 180 rotation. The propeller flap has been completely harvested and rotated. The skin island was planned to preserve the superficial sural artery flap as a secondary surgical option. Postoperative results after 6 months. The moderate thickness of the flap has allowed reconstruction with an adequate contour of the ankle. Clin Plastic Surg，2010； 37: 615–626 两个穿支共同为蒂？ 扭结在一起 文献5：教程讲座 (A) Traumatic soft tissue loss on the medial malleolus with exposure of the tibia. After the main perforator, arising from the posterior tibial artery, has been located with a handheld Doppler ultrasound scanner, the flap is planned around it. (B) A generous exploratory incision is made on the posterior border of the flap and the perforatoron which the flap is based is visualized. (C, D) Meticulous dissection of the perforator. To avoid vascular compromise the perforator should be skeletonized completely by dividing all the fascial strands that could causeextrinsic compression, particularly of the venae comitantes, once the flap is rotated. (E, F) The flap, completely islanded on a single perforator, is then rotated to cover the defect. (G) Result at 1 month after surgery. J Hand Surg 2011;36A:853–863 The extent of dissection of the perforator depends on the degree of flap rotation required. One has to balance the risk of greater perforator dissecti