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目的通过CT血管造影(CT angiography,CTA)三维重建测量肋软骨宽度、厚度以及肋间隙距离,探讨采用截断下位肋软骨延伸蒂部的腹直肌肌皮瓣修复颈胸部创面的可行性。方法以2013年7月-12月行胸部CTA的30例患者作为研究对象,其中男17例,女13例;年龄44~70岁,平均56岁。于CTA三维重建图像上测量第3~7肋软骨宽度、厚度以及第3~6肋肋间隙距离,计算顺序截断第7、6、5、4肋软骨后蒂部延伸长度。2012年7月-2013年11月,采用该方法延长带蒂腹直肌肌皮瓣的蒂部后修复4例颈胸部创面。结果常规方法切取腹直肌肌皮瓣蒂部长度约为6 cm;按顺序截断左侧第7、6、5、4肋软骨后,皮瓣蒂部可平均延长4.07、7.99、12.50、17.48 cm;按顺序截断右侧第7、6、5、4肋软骨后,皮瓣蒂部平均延长4.63、10.82、16.64、22.05 cm。临床应用4例中,术后3例皮瓣顺利成活,1例皮瓣远端发生部分坏死,经对症处理后成活。除1例失访外,其余3例均获随访6个月,皮瓣外观、质地均较满意。结论截断下位肋软骨可以延伸带蒂腹直肌肌皮瓣的蒂部,能满足修复颈胸部创面的要求。
OBJECTIVE: To evaluate the feasibility of repairing neck and thoracic wound using the rectus abdominis myocutaneous flap pedicled with the lower costal cartilage extended by three-dimensional reconstruction of CT angiography (CTA). Methods Thirty patients with thoracic CTA from July 2013 to December 2013 were enrolled in this study. There were 17 males and 13 females, aged from 44 to 70 years (average 56 years). The width and thickness of 3rd to 7th cartilages and the 3rd to 6th intercostal space distances were measured on 3D reconstruction images of CTA. From July 2012 to November 2013, 4 cases of cervical and thoracic wounds were repaired by this method after the pedicle of pedicled rectus abdominis muscle flap was extended. Results The length of pedicle flap of the rectus abdominis myocutaneous flap was 6 cm. The pedicle flap was extended 4.07, 7.99, 12.50, 17.48 cm ; Cut off the right side of the first 7,6,5,4 costal cartilage, pedicle pedicle average extension of 4.63,10.82,16.64,22.05 cm. In 4 cases of clinical application, 3 cases of postoperative flap survived successfully, 1 case had distal necrosis of the flap and survived symptomatic treatment. Except for 1 case lost, the remaining 3 cases were followed up for 6 months. The appearance and texture of the flap were satisfactory. Conclusion The truncated lower costal cartilage can extend the pedicle of the pedicled rectus abdominis myocutaneous flap, which can meet the requirements of repairing the neck and thoracic wound.