腹股沟皮瓣.docxVIP

腹股沟皮瓣?? THE GROIN FLAPSkin and fat. The first skin free flap ever performed.Innervation: Not sensate.Blood supply: Superficial circumflex iliac artery from the external iliac/superficial femoral artery.Artery: Small caliber of 1 to 2 millimeters.Vein(s): Drained by the cutaneous vein, slightly larger in size than the artery. The artery usually drains into the saphenous system.Pedicle length: From 2 to 5 centimeters. Length depends on size and position of the skin paddle. Not a flap to choose if you want a long pedicle.血管解剖?? VASCULAR ANATOMY?腹股沟皮瓣靠旋髂浅动脉供血，该动脉起自股浅动脉，静脉回流入隐静脉，缝匠肌提供解剖定位标志。手术操作?? OPERATIVE PROCEDURE? ??? ? ?患者平卧位，如果预期取皮瓣较长，建议在同侧下方置垫以便于显露皮瓣的远端。缝匠肌、腹股沟韧带、和髂棘都很容易触及，根据其解剖标志设计皮瓣，用画线笔沿动脉走形设计皮瓣，通常，皮瓣的近端位于腹股沟韧带下方，宽度为一横指，皮瓣的最大宽度根据手捏能提起的皮肤决定，最好可以直接闭合伤口。?皮瓣在腹股沟下方处宽度保留一个手指宽度。用简单多普勒可以用来确定皮瓣远端动脉位置。?皮瓣可以从内侧或外侧切开，我们更倾向于在皮瓣上方切开，从远端向内下方分离。皮瓣要在深筋膜上方分离。? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ??缝匠肌是很有用的解剖标志，沿肌肉筋膜外侧切开，在肌筋膜下方分离，找到旋髂浅动脉，并注意保护。注意结扎血管肌支。?找到动静脉起点后结扎切断备用