游离背阔肌分叶肌皮瓣修复小腿软组织缺损  

Clinical application of free latissimus dorsi lobulated musculocutaneous flap for repair of tissue defect of the shank

作　　者：董玉金 张铁慧 徐连春 Dong Yujin;Zhang Tiehui;Xu Lianchun(Department of Foot and Hand Surgery,Dalian Municipal Central Hospital of Dalian Medical University,Dalian 116033,China)

机构地区：[1]大连医科大学附属大连市中心医院手足外科,116033

出　　处：《中华骨科杂志》2019年第4期251-256,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨应用游离背阔肌分叶肌皮瓣修复小腿软组织缺损的临床疗效。方法回顾性分析2011年1月至2016年12月采用游离背阔肌分叶肌皮瓣修复小腿软组织缺损22例患者的病历资料,男16例,女6例;年龄20-55岁,平均(37.5±2.5)岁。均为小腿部皮肤软组织缺损,创面均伴有肌腱、骨或内固定外露,软组织缺损面积达18 cm×10 cm- 28 cm×15 cm。根据术前多普勒超声确定皮瓣穿支血管部位,以此为中心,根据缺损创面的形状及大小设计分叶皮瓣。术中肌皮瓣切取过程中保留胸背神经及部分背阔肌,游离肌皮瓣形成分叶肌皮瓣;最终仅有血管蒂与皮瓣相连时游离血管蒂至合适长度;将两叶肌皮瓣合并形成一体皮瓣后修整皮瓣,自外周至血管皮支穿出点附近按次序阶梯样削除皮下脂肪,一体肌皮瓣四周可仅保留真皮层,同时观察皮瓣血供,防止穿支血管损伤;肌皮瓣修薄后游离移植修复小腿创面。供区均直接缝合。采用手外科手术学皮瓣综合评定标准评估临床疗效。结果22例肌皮瓣移植手术均顺利完成,肌皮瓣面积为20 cm×12 cm-30 cm×16 cm,术后均无血管危象发生,皮瓣均顺利成活。22例术后经6个月-2年随访,术后肌皮瓣质地柔软,弹性好,无臃肿,肤色接近正常皮肤,感觉功能恢复良好,两点辨别觉为3.5-5.0 cm,足踝功能及外形恢复良好。根据手外科手术学皮瓣综合评定标准,优13例、良8例、可1例,优良率达95.45%(21/22)。1例皮瓣远端出现约1.0 cm×0.5 cm浅表坏死,经换药后愈合。结论游离背阔肌分叶肌皮瓣是传统背阔肌皮瓣的改进,肌皮瓣存活率高,修复小腿软组织缺损疗效满意。Objective To explore the clinical outcomes of free latissimus dorsi lobulated musculocutaneous flap for repairing the soft tissue defects of the shank.Methods From January 2011 to December 12, free latissimus dorsi lobulated musculocutaneous flap was transferred to repair soft tissue defects of the shank in 22 cases. There were 16 males and 6 females retrospectivelyanalyzed, with an average age of 37.5±2.5 years. The wounds all had tendon,bone and/or internal fixation exposed. The size of the defect area was 18 cm×10 cm to 28 cm×15 cm. At first, the site of perforator vessels was determined by Doppler as the center, then the lobulated flaps were designedaccording to the wound shape and size. During the operation, the thoracic and dorsal nerves and part of latissimus dorsi muscle were preserved, and the myocutaneous flap was formed into lobulated myocutaneous flap. Finally, the pedicle was dissociated to the appropriate lengthwhen only the vascular pedicle was connected with the flap. After the combination of the two lobulated myocutaneous flaps, the skin flap was trimmed, and the subcutaneous fat was removed in a step-like way from the peripheral to the point of perforation of vascular cutaneous branches. Only the dermis was retained around the integral skin flap, and the blood supply of the skin flap was observed at the same time to prevent the injury of perforating vessels. The transplantation of musculocutaneous flap was performed to repair the leg wound. All donor sites were sutured directly. The flap survival was observed according to the comprehensive evaluation standard of hand surgery.Results All the 22 flaps survived, and the size of lobulated musculocutaneous flap was 20 cm×12 cm to 30 cm×16 cm. No vascular crisis happened, and all skin grafts survived in donor sites. 22 cases were follow-up for 6 to 24 months. The flaps were supple and elastic with nearly normal color. There was no bulkiness. Sensory function recovered well and two-point discrimination (2-PD) was about 3.5-5.0 cm. The function and

关 键 词：小腿 软组织损伤 外科皮瓣 治疗结果 

分 类 号：R658.3[医药卫生—外科学]