带蒂联合皮瓣移植修复上肢广泛软组织缺损  

Repair of large defects in upper extremities with pedicled combined flap

作　　者：黄旭[1] 谢庭鸿[1] 杨兴华[1] 张明华[1] 张丕红[1] 龙剑虹[1] 黄晓元[1] 

机构地区：[1]中南大学湘雅医院烧伤整形科,长沙410008

出　　处：《中华整形外科杂志》2008年第5期368-370,共3页Chinese Journal of Plastic Surgery

摘　　要：目的探讨上肢广泛软组织缺损皮瓣修复方法的选择。方法12例肘部、前臂及腕掌部高压电烧伤、热压伤及碾压伤患者，清创后4例应用背阔肌肌皮瓣与髂腰部皮瓣联合修复，将背阔肌肌皮瓣部分形成岛状，胸背血管蒂通过腋窝，上臂内侧皮下，髂腰部皮瓣部分以旋髂浅血管为蒂，皮瓣的蒂部形成皮管，位于腹股沟处，3周后再行断蒂；2例背阔肌肌皮瓣与侧胸皮瓣联合，将胸背动静脉游离出置于侧胸皮瓣内后形成皮管，蒂部位于侧胸上部；6例以巨大胸腹部联合皮瓣带蒂转移修复，以脐旁血管及肋间血管外侧皮支为轴，形成巨大皮瓣包绕前臂环形创面。结果1例皮瓣远端局限坏死2cm及皮瓣下感染，余全部成活，效果满意。结论上肢创伤广泛软组织缺损，早期清创，应用带蒂联合皮瓣、肌皮瓣修复是一种简单、安全、可靠的方法。Objective To explore the flap transposition for repairing large defects in upper extremities. Methods 12 cases with large defects in elbow, forearm, wrist or palm caused by high-voltage electricity, hot- pressure or crush, were treated. 4 cases were treated with latissimus dorsal myocutaneous flaps combined iliolumbar flaps. 2 cases were treated with latissimus dorsal myocutaneous flaps combined lateral thoracic flaps. 6 cases were treated with large combined thoracic-abdomen flaps. Results All the flaps survived except for one flap with 2 cm distal necrosis and sub-flap infection. Satisfactory results were achieved. Conclusions Early debridment and reconstruction with pedicled combined flaps are feasible and reliable for large defects in the upper extremities.

关 键 词：烧伤 电 外科皮瓣 软组织损伤 

分 类 号：R658[医药卫生—外科学]