游离背阔肌皮瓣移植修复上肢皮肤软组织缺损  

Repairing soft tissue defects in upper extremities with free latissimus dorsi musculocutaneous flaps

作　　者：曾昕明[1] 赵军[1] 王鹏程[1] 吴秀娟[1] 陈庆槐[1] 李建杭[1] 李建球[1] 

机构地区：[1]东莞市人民医院手外科,广东东莞511700

出　　处：《中国医学工程》2010年第2期62-64,共3页China Medical Engineering

摘　　要：目的探讨游离背阔肌皮瓣移植修复上肢皮肤软组织缺损的临床效果。方法 2005年7月～2009年8月,采用游离背阔肌皮瓣移植修复上肢皮肤软组织缺损创面16例。其中挤压伤6例,热压伤5例,机器绞轧脱套伤2例,电伤击伤1例,爆炸伤1例,蛇咬伤1例。均合并骨,肌腱外露,合并骨折7例,合并关节开放感染6例。合并血管神经损伤4例,5例伴屈、伸肘功能障碍。皮肤软组织缺损缺损面积6cm×13cm～15cm×32cm;切取背阔肌皮瓣7cm×14cm～16cm×35cm,供区均以中厚皮片移植修复。结果 16例背阔肌皮瓣全部成活,创面愈合满意。术后获随访2～31个月,其中5例皮瓣外形臃肿,二期行皮瓣修薄整形术;重建感觉的5例患者3例恢复保护性感觉。3例以背阔肌作动力重建屈、伸肘关节功能部分恢复。3例供区植皮部分坏死,其中2例经换药后治愈,l例二期植皮修复,余供区植皮均成活。结论背阔肌皮瓣血运丰富,具有很强的抗感染能力。且切取面积大,并同时以背阔肌可作动力重建屈、伸肘关节功能。是修复上肢皮肤软组织缺损和骨外露感染创面的较为理想皮瓣之一。【Objective】To explore the result of repairing soft tissue defects in upper extremities with free latissimus dorsi musculocutaneous flaps.【Methods】From July 2005 to August 2009,16 cases of complex soft tissue defects in upper extremities were repaired with free latissimus dorsi dorsi musculocutaneous flaps.The defect was caused by crushed injury in 6 cases,by hot press injury in 5 cases,by machine-inflicted soft tissue degloving injury in 2 cases,by electrical injury,blown injury and snake-biting injury in 1 case respectively.All cases were accompanied with exposure of bones and tendons,7 cases with fracture,6 cases with open infection of joint,4 cases with vessel injury or nerve injury,5 cases with elbow joint dysfunction.The size of defects ranged from 6cm × 13cm ～ 15cm × 32cm and the size of the flaps ranged from 7cm × 14cm ～ 16cm × 35cm.The donor sites were coverd with split-thickness skin grafts.【Results】All the flaps survived completely and the wounds healed primarily.The follow-up period ranged from 2 to 31 months.5 cases required further debulking procedure because of excessive volume of the flaps.In 5 cases of sensation reconstruction,protective sensation recoverd in 3 cases.3 cases of elbow joint reconstruction r-gained partial range of extension and flexion movement.3 cases had partial graft necrosis in donor site,2 cases of them were treated with extensive dress changings and 1 case with secondary skin grafting.【Conclusions】The free latissimus dorsi musculocutaneous flap is an ideal flap for repairing soft tissue defect complicated with bone exposure in upper extremity because it has advantages such as abundant blood supply,vast size of flap and excellent ability to resist infection and reconstruct elbow joint.

关 键 词：背阔肌皮瓣 游离移植 上肢 皮肤软组织缺损 

分 类 号：R622.1[医药卫生—整形外科]