摘要目的 探讨股前外侧皮瓣术前三纵五横法设计的可行性.方法 2015年9月至2017年1月共切取了71例患者73块股前外侧皮瓣,均为遵义医科大学附属医院就诊的患者,男48例,女23例,年龄(36±18)岁.术前采用三纵五横法设计,使用便携式多普勒在Ⅰ、Ⅱ、Ⅲ、Ⅳ区探测穿支穿出点(出肌点,P点).术中观察了穿支出肌点口径、离开出肌点后的走行、距离(穿支血管皮下段)及进入浅筋膜的位置(入皮点).结果 本组统计71例成年人,73条大腿的相关数据.术前和术中发现所有穿支均位于Ⅰ、Ⅱ、Ⅲ、Ⅳ区内.Ⅰ区穿支数量(1.32±0.33)条,穿支出肌点血管外径(0.79±0.13)mm,穿支血管皮下段长度(1.54±0.97)cm,方向:斜向外上方;Ⅱ区穿支数量(1.21±0.53)条,穿支出肌点血管外径(0.63±0.13)mm,穿支血管皮下段长度(2.25±0.54)cm,方向:斜向内下方,入皮点距离L线(0.84±0.42)cm;Ⅲ区穿支数量(2.22±0.49)条,穿支出肌点血管外径(0.53±0.12)mm,穿支血管皮下段长度(1.96±0.44)cm,方向:斜向内下方,入皮点距离L线(0.74±0.51)cm;Ⅳ区穿支数量(1.41±0.72)条,穿支血管皮下段长度(1.22±0.45)cm,方向:斜向外下方.本组具有斜支穿支27例,占总供区大腿数37％(27/73).结论 三纵五横设计方案有利于对股前外侧区穿支出肌点探测,有助于皮瓣设计.

abstractsObjective To explore the feasibility of preoperative designing for anterolateral femoral flap using three longitudinal and five transversal strategy. Methods From September 2015 to January 2017, 71 patients ( 73 pieces) were treated using anterolateral thigh flap in the Affiliated Hospital of Zunyi Medical University. There were 48 males and 23 females, with the age of ( 36 ± 18 ) years. The three longitudinal and five transversal designing was performed before operation. Portable Doppler ultrasound was used to detect the piercing-out position ( P point) of perforators in Ⅰ, Ⅱ, Ⅲ, Ⅳ areas. The diameter, direction and length ( lower subcutaneous segment of perforators) of perforators after leaving piercing-out position were observed during the operation. The piercing-in positions on superficial fascia and the dermis were observed.Results The data of 71 adults (73 legs) were evaluated. Before and during the operation, all the perforations were found in Ⅰ, Ⅱ, Ⅲ and Ⅳ areas. The number of perforators in region Ⅰ was 1. 32±0. 33, with the diameter of perforator at the piercing-out position was (0. 79±0. 13) mm. The length of subfascial segment of perforators was (1. 54±0. 97) cm, and the direction was oblique superolateral. Thenumber of perforators in Ⅱ region was 1. 21 ± 0. 53, with the diameter of perforator at the piercing-out position was (0. 63±0. 13) mm. The length of subfascial segment of perforators was (2. 25±0. 54) cm, and the direction was oblique inferoanterior. The distance form piercing-in position to line L was (0. 84±0. 42) cm. The number of perforators in the Ⅲ area was 2. 22±0. 49, with the diameter of perforators at the piercing-out position was (0. 53±0. 12) mm. The length of subfascial segment of perforator was (1. 96±0. 44) cm, and the direction was oblique inferoanterior. The distance between piercing-in positions to line L was (0. 74± 0. 51) cm. The number of perforators in regionⅣwas 1. 41±0. 72, with the length of subfascial segment of perforators was ( 1. 22 ± 0. 45) cm and the direction was oblique inferolateral. There were 27 cases with oblique perforators, accounting for 37％ of the total number of thighs.Conclusions This three longitudinal and five transversal designing is helpful to detect the expenditure point in the anterolateral femoral region, and is assistant to skin flap designing.