携带少量肌袖的胸背动脉穿支皮瓣的临床应用  

Clinical application of thoracodorsal artery perforator flap with small muscle cuff

作　　者：沈华[1] 沈尊理[1] 张兆峰[1] 王永春[1] 贾万新[1] 黄一雄[1] 

机构地区：[1]上海交通大学附属第一人民医院整形科,上海200080

出　　处：《中国美容整形外科杂志》2010年第10期608-610,共3页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的 探讨携带少量肌袖的胸背动脉穿支皮瓣修复缺损创面的手术方法及临床效果.方法 自2005年3月至2009年12月,应用携带少量肌袖的游离胸背动脉穿支皮瓣修复10例皮肤缺损患者,其中头颈部肿瘤切除术后皮肤缺损者3例,四肢部位皮肤缺损者7例.在游离皮瓣过程中,将胸背神经和大部分背阔肌留存于供区.根据创面缺损情况设计携带穿支血管处的少量背阔肌肌袖的胸背动脉穿支皮瓣,皮瓣大小为4.5 cm×7.0 cm～6.5 cm×12.0 cm.供区直接拉拢缝合.结果 术后随访10例患者2～41个月,游离移植的皮瓣成活良好,缺损修复后其外形较满意;供区余留的背阔肌其收缩功能仍存在,切口愈合良好.结论 该术式中保留的部分背阔肌肌袖,既有利于保护穿支皮瓣,又可改善皮瓣的臃肿外形;保留了胸背神经和大部分背阔肌,使供区损伤较小,符合皮瓣切取原则.Objective To evaluate the method and effect of free thoracodorsal artery perforator flaps with a small muscle cuff on repair of soft tissue defects. Methods From March 2005 to December 2009, 10 patients with soft tissue defects in limbs, head and neck were treated by using free thoracodorsal artery perforator flaps with a small muscle cuff. Among the defects, 3 were caused by the head and neck tumor resection and 7 were in the limbs. During dissociating flap, thoracodorsal nerve and the most part of latissimus dorsi muscle were deposited in the donor site. A small portion of the latissimus dorsi muscle cuff was harvested including perforators. The flaps were harvested from 4.5 cm× 7.0 cm to 6.5 cm x 12.0 cm according to defect area. The donor sites were closed directly. Results Totally 10 cases were followed up for 2 -41 months postoperatively. All free thoracodorsal artery perforator flaps with a small muscle cuff survived. The shape of the repaired defects was satisfactory ; the contractile function of remaining latissimus dorsi muscle in donor site was normal. The incision heal was well. Conclusion The revered small muscle cuff of latissimus dorsi muscle could both protect the thoracodorsal artery perforator flap and improve the aesthetic appearance of the flap. The reservation of thoracodorsal nerve and the most latissimus dorsi muscle could reduce the injury of donor site which was consistent with the flap harvesting principles.

关 键 词：穿支皮瓣 胸背动脉 背阔肌 游离移植 修复缺损 

分 类 号：R622.1[医药卫生—整形外科]