掌深弓手背穿支皮瓣的解剖学基础和临床应用

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1、分类号：R616.2学校代码：10392学科专业代码：105409学号：2151003603硕士学位论文掌深弓手背穿支皮瓣的解剖学基础和临床应用Theanatomybasicandclinicalapplicationsonthedorsalperforatorflapofthedeeppalmararch学位类型：专业学位所在学院：福总临床医学院申请人姓名：钮朋学科、专业：外科学（骨外）导师：郑和平教授研究起止日期：2015年10月至2018年2月答辩委员会主席：许卫红教授答辩日期：2018年5月24日二○一八年六月目录中文摘要„„„„„„„„„„„„„„„„

2、„„„„„„„„„1英文摘要„„„„„„„„„„„„„„„„„„„„„„„„„3前言„„„„„„„„„„„„„„„„„„„„„„„„„„„5第一部分掌深弓手背穿支皮瓣的临床解剖„„„„„„„„61.材料与方法„„„„„„„„„„„„„„„„„„„„„62.结果„„„„„„„„„„„„„„„„„„„„„„„„103.讨论„„„„„„„„„„„„„„„„„„„„„„„„13第二部分掌深弓手背穿支皮瓣的临床应用…………………154.临床资料„„„„„„„„„„„„„„„„„„„„„„155.结果„„„„„„„„„„„„„„„„„„„„„„„„176.讨论„„„„„„„

3、„„„„„„„„„„„„„„„19结论„„„„„„„„„„„„„„„„„„„„„„„„„„20参考文献„„„„„„„„„„„„„„„„„„„„„„„„„21综述„„„„„„„„„„„„„„„„„„„„„„„„„„24致谢„„„„„„„„„„„„„„„„„„„„„„„„„„32攻读学位期间的研究成果„„„„„„„„„„„„„„„„„33福建医科大学硕士研究生毕业论文中文摘要目的:（1）探讨掌深弓手背穿支血管的形态学特征，为临床上穿支蒂V-Y推进皮瓣设计提供解剖学基础。（2）总结应用掌深弓手背穿支皮瓣修复手部皮肤软组织缺损的方法和临床效果。方法:（1）显微解剖：选用

4、31侧经动脉内灌注红色乳胶的成人手标本，手术放大镜下重点解剖观测：①掌深弓手背穿支的起源、走行、分支与分布；②掌深弓手背穿支与腕背、掌背血管网的吻合特点。另1侧灌注红色乳胶的新鲜标本进行摹拟手术设计。拍摄解剖实例图片，采集数据并统计分析。（2）临床应用：根据解剖学资料，2015年10月-2017年12月应用掌深弓手背穿支皮瓣修复掌背软组织缺损5例，虎口区软组织缺损2例。拍摄临床实例图片，术后随访并总结评估。结果:（1）显微解剖：掌深弓手背穿支共有3支，穿过第2～4骨间背侧肌两头间至手背分为升、降2支，升支与腕背网吻合、降支延续为2～4掌背动脉。掌深弓第1～3手背

5、穿支起始外径分别为（1.1±0.2）mm、（0.9±0.3）mm、（0.7±0.1）mm，干长分别为（1.1±0.3）cm、（1.0±0.2）cm、（0.9±0.1）cm。（2）临床应用：7例皮瓣术后完全成活，患者供区切口均1期愈合。7例病例均获得随访，随访时间5～12个月，平均7个月。皮瓣质地、颜色与正常手背软组织相似，不臃肿，有不同程度的感觉功能恢复，部分供区有瘢痕增生，术后未发生肌腱粘连等并发症。结论:（1）掌深弓手背穿支出现率高，穿出点恒定，且与手背、腕背动脉网吻合，参与营养手背皮肤。3条穿支定有1支可供临床选择。所以以掌深弓手背穿支为蒂，可形成V-Y推

6、进皮瓣修复掌背部软组织缺损。（2）掌深弓手背穿支皮瓣具有切取方便，与受区位置邻近，皮肤组织质地、-1-福建医科大学硕士研究生毕业论文结构均与受区相近，修复后的外形、功能与感觉恢复良好，是修补手部外伤后中、小面积软组织缺损的一种行之有效的方法。关键词：掌深弓穿支穿支皮瓣组织缺损-2-福建医科大学硕士研究生毕业论文ABSTRACTObjective:⑴Toinvestigatethemorphologicalcharactersofthedorsalperforatorsoriginedfromthedeeppalmararch,forprovidinganatom

7、icknowledgeofV-Yadvancedperforatorflap.⑵ToinvestigatetheclinicalfeaturesoftheflapbasedontheperforatoroftheDeeppalmararch,andprovidetheclinicalevidenceforthepromotionofthisflap.Method：⑴Microscopicanatomy:Thefollowingcontentswereinvestigatedin31adulthandspecimensperfusedwithredlatexund

8、ersurgicalma