多种背阔肌瓣游离移植修复下肢缺损  

Application of latissimus dorsi flap in different forms in repair of skin and soft tissue defects in lower extremities

作　　者：张丕红[1] 黄晓元[1] 龙剑虹[1] 范鹏举[1] 任利成[1] 曾纪章[1] 肖目张[1] 

机构地区：[1]中南大学湘雅医院烧伤整形科,长沙410008

出　　处：《中华烧伤杂志》2009年第1期18-21,共4页Chinese Journal of Burns

摘　　要：目的寻找应用背阔肌瓣游离移植修复下肢缺损的方法。方法1996年2月-2008年2月，笔者单位应用游离背阔肌瓣修复下肢皮肤及组织缺损患者42例，其中膝部4例，小腿22例，足、踝部15例，膝下至足背严重撕脱1例。清创后采用背阔肌肌皮瓣、背阔肌肌瓣植皮、保留肌袖的背阔肌穿支皮瓣、分叶背阔肌组织瓣修复创面。组织瓣切取范同18cm×8cm～40cm×18cm。结果除3例患者术后发生血管危象，2例供区植皮和1例肌瓣植皮部分坏死外，其余患者创面均一次性愈合。随访3～24个月，6例患者皮瓣外形臃肿，影响穿鞋，再次行皮瓣修薄术；3例肌瓣植皮区有轻度瘢痕挛缩。结论个性化设计不同形式的背阔肌瓣，可满足下肢皮肤软组织缺损的修复。Objective To explore repair methods of skin and soft tissue defects in lower extremities with free latissimus dorsi flaps. Methods Forty-two patients with wounds and soft tissue defects in lower extremities, including 4 cases on knee, 22 cases on leg, 15 cases on ankle and foot, 1 case with extensive a- vulsion from knee to dorsum of foot, were hospitalized in our unit from February 1996 to February 2008. Wounds or soft tissue defects were respectively repaired with latissimus dorsi musculocutaneous flaps, latissi- mus dorsi muscle flaps, latissimus dorsi perforator flaps with preserved vascular sleeves, 2 double-leaf seg- mental latissimus dorsi compound flaps after debridement. The flaps ranged from 18 cm × 8 cm to 40 cm × 18 cm in size. The donor sites were covered by skin grafting in 19 cases. Results All wounds were healed primarily except vascular crisis occurred in 3 cases, partial necrosis of skin at donor site in 2 cases, and graft site（ 1 case）. Follow-up for 3 to 24 months of 31 patients showed： six cases received two-stage plastic operation on account of bulkiness with trouble in wearing shoes, and mild contraction of muscular flap in 3 cases. Conclusions Latissimus dorsi flap in various forms can be satisfactory for repair of large skin and soft tissue defects in lower extremities.

关 键 词：外科皮瓣 下肢 软组织损伤 修复 

分 类 号：R658.3[医药卫生—外科学] R782.24[医药卫生—临床医学]