目的

探讨术前组织瓣轴心动脉超声检测在组织瓣选择和设计中的应用价值。

方法

组织瓣转移修复术前，对116 例患者的137 条轴心动脉进行高频超声检测，判断其有无变异及动脉硬化，测量其内径、斑块大小、狭窄度及血流，对其走行进行体表定位并与术中所见进行对照。 术后随访组织瓣存活情况。

结果

超声检测发现1 例单侧颈横动脉缺如，其余137 条轴心动脉均能显示。 14 例患者的17 条（17/137，12.4%）轴心动脉存在明显的动脉硬化及不同程度的管腔变细或局部狭窄，其中血管内径最细仅约0.5 mm，内径狭窄度最大达50%。 除3 例在术中没有使用皮瓣外，113 例患者均根据超声检测结果选择了组织瓣，其中9 例（9/113，7.96%）在术中选择了备用组织瓣。 113 例的轴心动脉体表定位与术中对照均一致。 术后随访2 ～36 周，110 例（110/113，97.3%）患者（包括术中选择备用组织瓣的9 例）组织瓣存活，2 例（2/113，1.77%）部分坏死，1 例（1/113，0.89%）完全坏死。

结论

带轴心动脉组织瓣转移修复口腔颌面部组织缺损术前高频超声检测可以明确组织瓣轴心动脉有无变异或动脉硬化，评价轴心动脉的血管条件及血流情况，并准确进行体表定位，为临床上选择和设计组织瓣提供有价值的参考信息。

Objective

To investigate the value of preoperative high-frequency ultrasonography （HFUS） in selection and design of vascularized myocutaneous flaps.

Methods

In 116 cases， 137 axial arteries were detected with HFUS preoperatively. The diameters， plaque sizes and stenosis rates of arteries were measured. The origination， course and location of the arteries were marked on the skin of the patients and compared with the intra-operative findings.The survival of the flaps was followed up post-operatively.

Results

Right transverse cervical artery（TCA） was detected to be absent in one patient. The other 137 axial arteries out of 116 cases were demonstrated by HFUS successfully. In 17 out of 137 axial arteries， vascular sclerosis and/or stenosis were found （17/137，12.4%）. The minimal diameter of artery was only 0.5 mm and the maximal stenosis rate was about 50%. Myocutaneous flaps were used in 113 patients （except 3），including 9 alternative myocutaneous flaps （9/113，7.96%）. The origination， course and location of the arteries marked preoperatively on 113 patients' body surface were almost exactly matched the intra-operative findings. During 2 ～36 months' follow-up， myocutaneous flaps in 110 cases（110/113，97.3%） survived well. However， partial necrosis occurred in two myocutaneous flaps（2/113，1.77%） and compete necrosis occurred in one （1/113，0.89%）.

Conclusions

With HFUS， the axial arteries can be accurately assessed and exactly marked on the surface of the patients. It is suggested that HFUS is useful in the selection and design of vascularized myocutaneous flaps for the reconstruction of oromaxillo-facial defects.