带血管蒂组织瓣移位术解剖与基本原则课件.ppt

1、Changzheng .Changzheng .Changzheng.Changzheng.Changzheng.Changzheng.Changzhengdirect cutaneous artery.Changzhengmusculocutaneous artery.Changzheng.ChangzhengBlood supply of muscle.Changzheng.ChangzhengVascular plexus up-fasciaVascular plexus sub-fasciaFasciaSkinMuscleRamus of musculocutaneous artery

2、Vessel between muscles.ChangzhengClassification of skin flaps .Changzheng筋筋 膜膜 皮皮 瓣瓣 .ChangzhengSkinSubcutaneus tissuemusclefascia profunda.Changzheng翻翻 转转 筋筋 膜膜 瓣瓣.Changzheng轴轴 型型 皮皮 瓣瓣.ChangzhengVessel between musclesSkinSubcutaneus tissuefascia profundamuscle.Changzheng肌肌 皮皮 瓣瓣Musculocutaneous fl

3、ap.Changzheng.Changzheng.Changzheng.ChangzhengMusculocutaneous flap with musculocutaneous pedicle.ChangzhengMusculocutaneous flap with musculosubcutaneous pedicle.Changzheng Musculocutaneous flap with muscle pedicle .ChangzhengMusculocutaneous island flap with vasonerval pedicle.Changzhengmusculocut

4、aneous flap.ChangzhengDesign of the flapPointaxis to transfer flapsLine axal line of the flapRangeextent to which the nutritional vessel can supplyArcboundary that the flap can reach.ChangzhengAxis and arc of flap.Changzhengv 创伤、溃疡、肿瘤切除所致软组织缺损创伤、溃疡、肿瘤切除所致软组织缺损 Soft tissue defect of any causes that c

5、ould not be reconstructed through conventional methodsv 四肢瘢痕挛缩畸形，切除瘢痕、矫正畸形四肢瘢痕挛缩畸形，切除瘢痕、矫正畸形有深部组织裸露有深部组织裸露 Malformation caused by scar crispation, bare deep tissues caused by scar excision and malformation rectificationIndication.Changzhengv需在瘢痕或窦道区进行骨、关节、需在瘢痕或窦道区进行骨、关节、 肌腱手术者肌腱手术者 Operations on bon

6、e, joint or tendons in regions of scars and sinuses v慢性骨髓炎病灶清除后有创面裸露慢性骨髓炎病灶清除后有创面裸露 Cavities of Supercilious ulcer, purulent osteomyelitis and bedsore that need to be cleaned up in phade 1 after thorough treatment. v感觉、运动功能重建及某些器官再造感觉、运动功能重建及某些器官再造 Wounds repair with simultaneous reconstruction of m

7、otor or nerve function.Indication.Changzhengv对供区功能、外观影响较小对供区功能、外观影响较小 The flap with less affect to donor site.v血管恒定、变异少，易于切取血管恒定、变异少，易于切取 The flap acquired easily and with less variable vessles v根据受区部位、大小、创面性质及根据受区部位、大小、创面性质及 功能要求选择皮瓣功能要求选择皮瓣 The flap suit for recipient site in position, size, quali

8、ty and function .Selection of flap.Changzhengv邻近创面的皮瓣，质地近似，转邻近创面的皮瓣，质地近似，转移方便，应优先选用移方便，应优先选用 The preferable flap with the character of adjacent to the recipient site, having similar texture and thickness and easily transferredSelection of flap according to recipient site.ChangzhengPlantar flap of fo

9、ot Dorsal flap of foot Crural flapcalcaneal defect.Changzhengv无骨和肌肉缺损的创面，选用轴型皮瓣无骨和肌肉缺损的创面，选用轴型皮瓣 The axial flap suitable for wound without defect of bone and musclev有骨或肌肉缺损的创面选用肌皮瓣较好有骨或肌肉缺损的创面选用肌皮瓣较好 The musculocutaneous flap suitable for wound with defect of bone and muscleSelection of flap accordi

10、ng to defect character .Changzhengv需同时恢复缺损区感觉功能时，应需同时恢复缺损区感觉功能时，应选用含感觉神经的皮瓣；需同时重选用含感觉神经的皮瓣；需同时重建缺损区肌肉功能时，应选用带运建缺损区肌肉功能时，应选用带运动神经的肌皮瓣。动神经的肌皮瓣。 If the function of movement or sense is required, the flap should be composed with the muscle or sense nerve. Selection of flap according to function requirem

11、ent of recipient site.ChangzhengSelection of flap according to the size of defectThe size of defect and flap should be considered. The size of flap should exceed that of the defect.Changzheng手 术 要 点 Operation outline.Changzhengv慢性感染创面需彻底病灶清除慢性感染创面需彻底病灶清除 The sinus, dead bone, inflammatory tissue wit

12、h poor blood supply must be thoroughly cleaned up. Preparation of the recipient site .Changzhengv先标明旋转中心位置及皮瓣纵先标明旋转中心位置及皮瓣纵轴线，根据创面形状及大小设轴线，根据创面形状及大小设计皮瓣计皮瓣 First, make sure the position of the vascular pedicle and the nutritional vessel of the flap, then mark it on the skin.Design the flap according

13、 to the shape and size of the defect.皮瓣设计皮瓣设计 Design of the flap .Changzheng.Changzheng Repair the sacrum bedsore using the myocutaneous superior of Muscle gluteus maximus.Changzhengv顺行切取顺行切取 先显露血管蒂部先显露血管蒂部,由近向远分离皮瓣由近向远分离皮瓣 First, expose the vascular pedicle, and then cut off the flap along the boun

14、dary of the flap.v逆行切取逆行切取 从皮瓣远端开始从皮瓣远端开始,由远向近切取皮瓣由远向近切取皮瓣 First, cut off the flap, and then dissociate the vascular pedicle.皮瓣切取皮瓣切取 operation mannersClassical mannerReverse manner.ChangzhengClassical mannerReverse manner.Changzhengv皮瓣移位皮瓣移位 Shiftv皮瓣推进皮瓣推进 Advancementv皮瓣旋转皮瓣旋转 Rotationv交叉移植交叉移植 cro

15、ssing皮瓣转移皮瓣转移 Flap transfer.Changzheng皮皮 瓣瓣 移移 位位Shift of flap.Changzheng.Changzheng皮皮 瓣瓣 推推 进进Advancement of flap.Changzheng.Changzheng.Changzheng皮皮 瓣瓣 旋旋 转转Rotation of flap.Changzheng.Changzheng.Changzheng交交 叉叉 移移 植植Cross transplant.Changzheng.Changzheng Notes Choose the normal skin and muscle as

16、donor tissue. The sinus, dead bone, inflammatory tissue with poor blood supply must be thoroughly cleaned. Cut the flap according to the anatomical arrangement to avoid vessel separation from the flap, and muscle from the skin. .Changzheng Notes If the myocutaneous flap is needed, and the skin scope exceeds that of the muscle, the fascia profunda should be reserved completely . During the operation, vascular pedicle should not be curled, pressed and retorted.Changzheng谢谢大家谢谢大家Thank You !Thank You !.