DONG MACH THU-aNG NONG GIAI PHAU NONG PHU THUOC MACH MU CHAU NONG

Y HOC VIET NAM THANG 7 - SO 1/2014

GIAI PHAU VAT BEN NONG PHU THUOC VAO D Q N G MACH MU CHAU NONG VA DONG MACH THU-aNG VI NONG

T O M TAT

Oat van de: Vat da vung ben giup che phu cac khuyet hong rpng ciia phan mem va chu yeu diTpc cap mau bdi dpng mach mu chau nong va dpng mach thu'dng vj nong. Muc tieu: Chung toi mo ta dang cap mau dien hinh, dang thay do! cua dpng mach mu chau nong va dpng mach thu'dng vj nong, xac (Jjnh ki'ch thu'dc cuong mach nuoi vat ben nong. Phu'dng phap nghien cihi: Nghien ciitJ mo ta cSt ngang 30 tieu ban phau tfch VLing ben tren xac u'dp formalin tai bp mon glai phau tru'dng -DHYDCT. Ket qua: Dpng mach mu chau nong (DMMCN) hien dien d tat ca cac tieu ban.

Co 76,67% tru'dng hdp DMMCN tach ra tii' mat tru'dc ciia DM dui. Du'dng kfnh cua DMMCN trung binh la 1,29 ± 0,22 mm. Ti le phan nhanh tan ciia DMMCN la 93,33% (28/30 tieu ban), ti le khong phan nhanh tan la 6,67% (2/30 tieu ban). Chieu dai nhanh chung DMMCN trung binh la 13,11 ± 4,35 mm, Du'dng kinh trung binh nhanh nong va nhanh sau cua DMMCN theo thij'tM' la 1,06 ± 0,20 mm va 1,15 ± 0,24 mm. Chieu ih\ trung binh nhanh nong va nhanh sau cua DMMCN theo thu' t y la 28,33 ± 7,41 mm va 25,54 ± 8,75 mm.

n le xuat hien dpng m?ch thu'dng vi nong la 66,67%

[20/30 tieu ban). Trong nhuYig trUdng hpp co dpng ngch thUpng vj nong, ti le than chung ciia DMMCN va DMTVN la 70%, ti te tacti rieng re ciia 2 dpng mach nay ta 30%. Du'dng kfnh ciia OMTVN trung btnh la 1,23 ± 1,17 mm. Ti le than chung cua TMTVN va TMMCN la 53,33% (16/30 tieu ban). DUdng kinh than :hung TMMCN va TMTVN tmng binh la 2,40 ± 0,35 Tim. Du'dng kfnh trung binh ciia TMMCN va TMTVN :heo thuf t u la 1,68 ± 0,38 mm va 1,77 ± 0,35 mm.

Du'dng kfnh tinh mach tiiy hanh trung binh la 1,06 ± ),13 mm. Kgt luan: Giai phau ciia DMMCN va DMTVN

<h6ng hSng dinh. Co nhieu dang cap mau cho vat ben long. Do do, khi phlu thuat tai t?o bSng vat ben i6ng, phai xac djnh ro cuong mach nuoi du'dng.

SUIVIIVIARY

ANATOMY OF THE G R O I N FLAP BASED ON THE SUPERFICIAL CIRCUMFLEX I L I A C

ARTERY A N D THE SUPERFICIAL EPIGASTRIC ARTERY Background: The groin flap help cover the soft issue defect. The groin is supplied by the superficial :ircumflex iliac artery and the superficial epigastric irtery. Objectives: We described the anatomy of the

*^ Tru&ng Oai hoc Y DUdc CSn ThO

^han bign khoa hgc: PGS.TS Nguyen Van Huy

Nguyin Van Lam*

superficial circumflex iliac artery, the superficial epigastric artery and venous system supplied the groin flap. Methods: This control-study included 30 dissected specimens of the mummy's groin at the anatomical deparment at Can Tho University of Medicine and Pharmacy. Results: The superficial circumflex iliac artery (SCIA) was seen all specimens.

SOA orginated in the femoral artery was 76,67%.

Average diameter of tiie SQA was 1,29 ± 0,22 mm . The SCIA was 2 branchs: 93,33%. Average length of common branch of SCIA was 13,11 ± 4,35 mm.

Average diameter of superficial branch and deep branch of the SCIA were 1,06 ± 0,20 mm and 1,15 ± 0,24 mm, respectively . Average diameter of superficial branch and deep branch of the SCIA were 28,33 ± 7,41 mm and 25,54 ± 8,75 mm, respectively.

The superficial epigastnc artery (SEA) was 66,67%. Common branch of SCIA and SEA was 70%.

Average diameter of SEA was 1,23 ± 1,17 mm.

Common branch of the superficial epigastric vein and the superficial circumflex iliac vein was 53,33%.

Average diameter of this common vein branch was 2,40 ± 0,35 mm. Average diameter of the superficial circumflex iliac vein and the superficial epigastric vein were 1,68 ± 0,38 mm and 1,77 ± 0,35 mm, respectively. Average diameter of attendant vein was 1,06 ± 0,13 mm. Conclusions: Anatomy of the SGA and SEA was not constant. There were many types of blood supply for the groin flap, therefore, the pedicle of the groin flap should be identified certainly in reconstructive surgery.

I.

OAT VAN

OE

Vat da vung ben co nhieu uli diem nhu' kich thu'dc vat Idn, cho phep dong kin da tri/c tiep thi dau ndi lay vat va khong anh hu'dng d^n chii'c nang khi lay vat.

Tren the gidi da co nhieu bao cao ve nghien Cliil giai phau va uhg dung ciia vat ben tren lam sang. Tai Viet Nam cung cd nhuhg ngliien CLTU ve LTng dung cua vat ben, tuy nhien nghien ciili ve giai phau ciia vat ben nong con it so vdi nhu cau ngay cang lang ve chat lieu trong phau thuat tai tao.

II. PHirCTNG PHAP NGHIEN CO'U

Nghien CUIJ mo ta cat ngang du'dc tien hanh tren 30 tieu ban phau tfch viing ben d xac Wdp formalin ciia ngu'di Viet tru'dng thanh tal bp mon Giai Phau Tru'dng OHYD Can Thd.

Y HOC VIET NAM THANG 7 • SO 1/2014

III. KET QUA

3.1. Nguyen uy cua OMMCN ^ Dong mach mu chau nong (DI^MCN) hien dien d tat ca cac tieu ban,

Bang 1. Vi tri nguyen iiy ciia DMMCN VI tri nguyen iiy Dong mach diii Dong mach diii nong Dong mach diii sau Dong mach mu chau sau

So tru'dng htfp (n) 23

Ti 1^ c/o)

76,67

16,67

a 2. Oitisnq kinh ciJa BMMCN tai nguyen uy

Sifcing kinh (mm)

< 1 1-1,5 1,6-2

>2

So tru'dng hop (n) 2 22

6 0

Ti le (O/o) 6,67 73,33 20

0 BKnho nhat eua BMMCN la 0,84 mm, Idn nhat la 1,66 mm, TB la 1,29 ± 0,22 mm.

3.2. Bu'crng di v^ phan nhanli cua SMMCN

Ti le hinh thai phan nhanh tan cua OMMCN la 93,33% (28/30 tieu ban), ti le hinh thai khong phin nhanh tan la 6,67% (2/30 tieu ban).

Bing 3. Chieu dai nhanh chung BMMCN ChlSu dai (mm)

<15 15-25

>25

So tru'dng hdp (n) 22

Trong so 28 Heu ban DMMCN co chia 2 nhanh tan; nhanh nong va nhanh sau. Chieu dai nhanh Chung OMMCN <15 mm co 22 tru'dng hdp, chiem ti IS 78,57%. Chieu dai nhanh chung OMMCN tit 15-25 mm co 6 tri/dng hdp, chiem ti le 21,43%.

Tru'dng hdp nhanh chung OMMCN dai nhat la 22,84mm, ngan nhat la 4,78 mm va trung binh la

Ti le (%)

78,57 21,43

13,11±4,35 mm. Nhanh nong OMMCN: chpc ra mac dui ra nong tal bd trong cd may roi tiep tuc chay ra ngoai ve phia gal chau tru'dc tren trong mo du'di da. Nhanh nong len 161 giu'a cac hach bach huyet ben nong va tach ra cac nhanh liho vao cac hach bach huyet ben va da ben

Bing 4. Du'dng kinh nhanh nong cua OMMCN Du'dng kinh (mm)

<0,5

0,5-1

So tru'dng hdp (n)

10

Ti \% (%)

35,71 64,29

OKhhinh nong nho nhat li 0,64 mm, tdn nhat la 1,4 mm va TB li 1,06 ± 0,20 mm.

Bing 5. Chieu dai nhanh nong cua OMMCN Chieu dai (mm)

<15 15-25

>25

So tru'dng hdp(n) 2 5 21

Ti le (%) 7,14 17,86

75 Chieu dai nhanh nong ciJa OMMCN nho nhat la

12,56 mm, Idn nhat la 41,78 mm va trung binh la 28,33 ± 7,41 mm. Nhanh sau cua OMMCN: tiep tuc dl du'di mac diii theo hu'dng song song vdi day Chang ben, no bat cheo tru'dc than kinh bi dui ngoai, tach ra cac nhanh vao cd may roi xuyen qua mac dui vao mo m3 du'di da. Nhanh

sau thu'dng xuyen qua mac dui tai bd ngoai cd

may, difdi GCTT 1-2 cm. Sau khi xuyen qua mac

dill, nhanh sau bat cheo GCTT hoac di du'di GCTT

roi phSn ra cac nhanh tan tiep tuc chay sau

GCTT. Tai GCTT nhanh sau tach ra mpt so nhanh

nho chay vao mang xu'dng mao chau. Vung phan

nhanh vao da cua nhanh sau chii yeu sau GCTT.

Y HOC VIET NAM THANG 7 - SO 1/2014

Bina 6. Du'dna kinh nhanh sau cua DMMCN

DUdng kinh (mm)

<0,5 0,5-1

>1

So tru'dng hdp (n) 0 6 22

Ti le (»/o) 0 21,43 78,57 t/n nhanh sau nho nhat: 0,6 mm, Idn nhat: 1,58 mm va TB: 1,15 ± 0,24 mm.

Bing 7. Chieu dai nhanh sau ciia DMMCN Chieu dai (mm)

< 15 15-25

>25

So trudng hdp (n) 4 8 16

Ti le (%) 14,29 28,57 57,14

Chieu dai nhanh sau cua BMMCN nho nhai li 10,18 nim, Idn nhat li 46,88 mm vi tmng binh la2S,54±8,75 mm 3.3. Dong mach thu'dng vj nong

3.3.1. Vj tri nguyin iiy: ji le dong mach tht/dng vj nong xuat hien trong mau nghien culi cua chung toi ia 66,67% (20/30 tieu ban). Trong nhii'ng tru'dng hdp co dorig mach thu'dng vl nong, ti le than chung cua OMMCN va OMTVN la 70%, ti le tach rieng re cua 2 dong mach nay l i 30%.

Bangs. VI tri nquyen iiy ciia OMTVN Vi tri nguyen uy Than Chung vdi OMMCN

OMdiil

So tru'dng hdp (n) 14

6

Ti le (%) 70 30 3.3,2. Cu'dng kinh:

Bing 9. Du'dng kinh ciia OMTVt^

Du'dng kinh (mm)

< 1 1-1,5 1,6-2

>2

So tru'dng hdp (n) 3 15 2 0

Ti le (%) 15 75 10 0 3.4. Ccic tinh mach vung ben

Cac tlnh mach nong di is phjn nong cua mo md du'di da. a cac tieu ban phau tich viing ben, chiing toi luon gap 2 TM nong: TMTVN di d tren va trong hdn theo hu'dng gan song song vdl OMTVN, TMMCN dl d du'di va ngoai hdn theo hu'dng song song vdl OMMCN.

Ti le than chung ciia TMTVN va TMMCN la 53,33% (16/30 tieu ban).

Bing 10. Du'dng kinh than chung TMTVN va TMMCN Du'dng kinh (mm)

< 1 1-1-5 2,1-2,5

>2,5 Tong

So tru'dng hdp (n)

16

Ti le (%)

31,25 100

BKthin ehung TMMCN va TMTVN nhd nhat li 1,78mm, Idn nhat la 3,16mm va TB li 2,40±0,35mm Bang 11. Du'dng kinh TMMCN

Du'dng kinh (mm)

< 1 1-1,5 1,6-2 2,1-2,5

>2,5 Tonq

sa tru'dng hdp (n) 1 3 7 3 0 14

Ti le (%) 7,14 21,43 50 21,43

0

100

BK TMMCN nho nhat la 0,92 mm, Idn nhat la 2,36 mm va TB la 1,68 ± 0,38 mm.

Y HOC VIET NAM THANG 7 - SO 1/2014

Bing 12. Du'dnq kinh TMTVN DUdng kinh ( m m )

< 1 1-1,5 1,6-2 2,1-2,5

>2,5 Tonq

So tru'dng hdp ( n ) 1 1 9 3 0 14

T i le ( % ) 7,14 7,14 64,29 21,43 0 100 DKciia TMTVN nhd nhat la 0,7 mm, Idn nhat la 2,36 mm va IB la 1,// ± 0,35 mm.

3.5. Tinh mach tCiy hanh

Bina 13. Du'dnq kinh tTnh mach tiiy hanh DUdng kinh ( m m )

< 1 1-1,5 1,6-2 2,1-2,5

>2,5 Tong

So trUdng hdp ( n ) 10 20 0 0 0 30

T i le ( % ) 33,33 66,67 0 0 0 100

DKmach tuy hanh nho nhat la 0,82 mm, kin nhat la 1,32 mm va TB la 1,06 ± 0,13 mm.

IV. BAN LUAN

4.1. Nguyen uy cua DMMCN Nguyen uy cua DMMCN khong hang djnh.

4.1.1. DMMCN va DMTVN c i than chung Ti le DMMCN tach doc lap trong nghien cull cua Chung toi la 30%, thap hdn ti le ciia tac gla Smith (1972) la 93% va Harri (1979) la 70%. Ti le nay gan tu'dng du'dng vdl ti le ciia tac gia Taylor (1975) la 26% va Nguyen VSn Huy (1999) la 36,8%.

Ti IS DMMCN va OMTVN cd than chung trong nghiSn ciru nay la 70%, cao hdn ti IS ciia tac gla Smith (1972) la 7% va Harri (1979) ia 30%. Ti IS nay gan tu'dng du'dng vdl ti IS ciia tac gla Taylor (1975) la 74% va Huy (1999) la 63,2%

Tru'dng hdp co than chung giii'a DMMCN va DMTVN la CO ldl vi du'dng kinh cua than chung Idn hdn du'dng kinh OMMCN va DMTVN tach doc lap. Pham vi tu'di mau cua than chung Idn hdn ciia mpt OM rieng IS.

4.1.2. DMMCN vJ DMTVN tach ra tir cic nhanh DM idn

Tru'dng hdp OMMCN (va ca OMTVN) tach ra tir cac nhanh Idn hdn ciia OM chau ngoai va OM dili la tru'dng hdp viiS bat ldl virs co ldl. Oiem bat Idi do thay doi ve nguyen iiy nen can phai mo du'dng dai hdn, kho phau tich hdn, thdl gian mo dai hdn va co the ton thu'dng cac nhanh dong mach. Diem co ldl khi DMMCN tach ra tirOMIiicS

hoac DMMDN, CO the that va cat cac DM nay sau diem phat sinh DMMDN va sir dung doan gan lam cuong mach do du'dng kinh Idn hdn.

4.1.3. Ve dudng kinh cuong mach: theo Taylor, Ohmori, Nguyen Van Huy thi du'dng kinh cuong mach OMMCN co gla tri trSn lam sang khi

>1,0 mm. Tuy nhiSn cung co mpt U le nho DMMCN cd du'dng kinh khong thich hdp clio n5l vl mach.

Ti IS du'dng kinh ciia DMMCN du'di 1 mm trong nghien ciiti nay la 6,67%, ti IS nay cao hdn ti IS ciia Taylor (1975) la 2% va Ohmori (1975) la 4,2%.

Otrdng kinh va chieu dai trung binh ciia nhanh nong va nhanh sau trong nghlSn cii'u nay tu'dng du'dng vdi ket qua ciia Smith (1972).

Du'dng kinh nhanh nong trong nghiSn ciTu nay nho hdn du'dng kinh nhanh sau. Ve chieu dai nhanh nong dai hdn nhanh sau do nhanh nong de phau tich hdn. Trong qua trinh phlu tich Chung toi gSp kho khan khi phau tich nhanh sau do dl vao Idp cd. Day la diem quan trpng trong litig dung vat ben tren lam sang. Nhanh sau co the phan nhanh nhleu vao cd va trd nSn rat nho khi xuyen qua mac diii vao Idp md du'di da.

4.2. DMTVN 4.2.1. Ve nguyin iy

Ti le than chung cua DMMCN va OMTVN la

70%. Khi DMMCN va DlfrVN co than chung thi

viec lay vat rpng se dang ti'n cay hdn.

Y Hpc VlgT NAM THANG 7 - SO 112014 4 . 2 . 2 . V e d u d n g kinh

DMMCN CO du'dng kinh trung binh la 1,29±0,22 Idn hdn ciia DMTVN la 1,23±0,17. Ti IS du'dng kinh du'di 1 mm ciia DMMCN la 6,67%

thap hdn ciia DMTVN la 15%. Ket qua ciia nghiSn cu'u nay tu'dng du'dng vdl ket qua ciia Nguyen Van Huy (1999). Vi vay cuong mach OMMCN nuoi vat ben thu'dng difdc sir dung hdn la cuong mach OMTVN.

4.3. Tinh mach nong

So vdi DM, TM nong de phau tich hdn vi di trong Idp nong cua mo du'di da

DKTB than Chung TM trong nghlSn ciili nay la 2,40±0,35 mm Idn hdn DKTB ciia TMMCN la 1,68±0,3B mm va TMTVN la 1,77±0,35 m m . Ket qua nay tu'dng du'dng vdl ket qua ciia Ohmori (1975) va Nguyen Van Huy (1999).

Ti IS than Chung TM la 53,33% tu'dng du'dng vdl ti IS cua Ohmori (1975) la 55,2% va Nguyen van Huy (1999) la 5 7 % . Viec lua chpn TMMCN va TMTVN chi dat ra khi 2 tlnh mach nay do dpc lap. Viec lira chpn TM nong trong tru'dng hdp nay tiiy thupc vao viec chpn OM: khi da chpn OM Idn hdn trong hai DM cap mau cho vat ben, can chpn TM ndng di theo OM da chpn.

TM tuy hinh

DKTM tiiy hanh trong nghlSn cu'u nay la 1,06±0,13 m m , DKTB nay nho hdn DKTB ciia TMMCN la 1,68±0,38 va ciia TMTVN la 1,77±0,35. Ket qua ciia chung toi tu'dng du'dng vdi ket qua cua Ohmori (1975) va Nguyen Van Huy (1999).

DKTM tiiy hanh nhd hdn OKTMMCN va TMTVN. Ve u'ng dung lam sang, ngoai tac gia Harri, Chung toi chu'a thay tac gia nao si dung TM tiiy hanh de ndi vi mach. Cac tac gia khuySn siy dung TM nong de dan lull va chi nSn that cac cuong OM va TM khong dimg den sau khi da boc Ip xong toan bp cac cuong mach cua vat ben va lift chpn du'dc cac cuong mach phu hdp .

V. KET LUiSiN

Vat ben nong cd cuong mach phirc tap gom OMMCN (hoac OMTVN), 2 TM tiiy hanh va cac TM nong.

5 . 1 . N g u y e n uy va phdn nhanh cua D M M C N khong hSng djnh.

5 . 2 . Dang cap m a u dien hinh va kich t h u d c cuong mach nuoi v a t ben nong:

- 7 0 % OMMCN cd than chung vdl DMTVN, - 76,67% DMMCN tach ra t i r O M diii.

- 93,33% OMMCN co du'dng kinh tai nguySn iiy Idn hdn 1 mm, DKTB 1,29 ± 0,22 mm.

- 87,67% OMTVN CO du'dng kinh tai nguyen uy Idn hdn 1 mm, DKTB 1,23 ± 0,17 m m . - 93,33% DMMCN c6 2 nhanh vdl than chung dai trung binh 13,11±4,35 m m .

- 53,33% TMMCN va TMTVN CO than Chung tru'dc khi do vao TM hien hoac TM dill. DKTB than Chung la 2,40 ± 0,35 m m .

TM tiiy hanh cd OK nhd 1,06 ± 0,13 m m . 5.3. M o t so dang cap m a u khac cho v a t ben ndng

- 3 3 % khong cd DMTVN

- 3 0 % DMMCN va OMTVN cd nguyen iiy dpc lap vdi nhau

- 6,67% OMMCN khong phan nhanh.

- 46,67% TMMCN va TMTVN khong co than chung TAI L l f U THAIVI KHAO

1 . Tran Van Du'dng, Tran Nguyen Trinh Hgnh, Hufnh Minh Trieu, Tran Phu'dc Binh, Tru'dng Nguyen Khanh HUng (2012), "Danh gia ket qua dieu trj khuyet hong mo mem viing cang-ban tay bang vat da ben vl phau tai benh vien Chd Ray", Tap chi Chan thddng chinh hinh Viet Nam, So dSc biet, 313-319.

2. Tran Hoa (2005), "Vat da cu5ng ben che phii mat da va phan mem ban tay-cang tay", Ky yeu hoi nghi Chan thu'dng chinh hinh Viet Nam ^ n 4, TPHCI>1,' 28.

3. Nguyen Van Huy (1999), Nghien cdu glil phau vat cin da mac diil va cic vat ben, Luan an tien sT khoa Y DiTdc, Ha Npi.

4. Nguyin Vi?t Tien (2009), "T?a hinh khuyet hong phan mem viing ban tay bang vat ben co cuSng mach lien". Tap dvV Dttdc hoc quin sd,'^.

5. Giiosh, Jayakumar (2010), Tree groin flap transfer for recurrent severe contractures of the neck in children", Indian J Plastic Surgery, 43, 80-84.

6. Muresan, Dorafshar, Rodriguez (2012), "A reappraisal of the free groin flap in aesthetic cranio-faclal reconstruction", Ann Plastic Surgery, 68(2), 175-179.

7. Sonmez E., Nasir S., Safak T., Kecik A.

(2010), "Free groin flap applications in the pediatric population", Joumal Reconstructive Microsurgery, 26(4), 259-264.