医学胸背动脉皮瓣TDAP培训.ppt

胸背动脉皮瓣TDAP

ContentHistoryandDevelopmentDefinitionandFeaturesAnatomyClinicalapplicationMeritsShortcomings

History1989Koshimaperforatorflap1995AngrigianiTrunkPerforatorFlap(Firstreport).NamedlatissimusdorsiflapwithoutmuscleKim,Koshimacalleditthinninglatissimusdorsiflap2003Heitmannthoracodorsalarteryperforatatorflap(TDAP).Firstlynamed

DefinitionThroughthelatissimusdorsithoracodorsalarteryperforator,onlycontainingskinandfasciasuperficialis`axialpatternskinflap.

FeaturesCuttingflapindeepfascia;Reservelatissimusdorsi,nodamagenervithoracodorsalis;Directsutureofthedonorsitewithin7-10cm.

AppliedanatomyTherewere3to6perforatorsoffthedistalmainthoracodorsaland/oritslateralbranchwhichconstitutethevascularsupplyofthethoracodorsalarteryperforatorflap.Thefirstperforatorwaslocatedapproximately6~8cmbelowtheposterioraxillaryfold.Subsequentperforators,uptoatotalofthree,arisedat1.5~4cmintervalsinferiorlyoffthelateralbranch.Eachperforatordisplayeda3~5cmobliquecoursethroughthemuscletosupplytheoverlyingskin.Eachperforatingarterywas0.3~0.6mmindiameterandaccompaniedbytwovenaecomitans.

Fig.1A,Angiogramoftheintegumentofthechestandupperbackfromahumancadaverleadoxideandgelatininjectionspecimen.Theblacklineindicatesanoutlineofthelatissimusdorsi.B,Thedesignofthethoracodorsalarteryperforatorflap.Thereliablesizeofthethoracodorsalarteryperforatorflapthatcanbeelevatedonasingleperforator(TA-1)was15×8cm.Themaximumflapupto25cm×12cmwasharvestedontwoadjacentperforators(TA-1andTA-2).C,Angiogramofthelatissimusdorsimusclewiththethoracodorsalartery

ClinicalAnatomicAtlasofMicrosurgery

ClinicalAnatomicAtlasofMicrosurgery

ClinicalAnatomicAtlasofMicrosurgery

ClinicalapplicationPediclegraftingFreegrafting

PediclegraftingRepairingthewoundsofhomony