修薄游离肌瓣修复手足软组织缺损  

Thinning of the free muscle flaps for the treatment of hand and foot defects

作　　者：陈建武[1] 宋保强[1] 陈晨[1] 张栋梁[1] 王钠[1] 马显杰[1] 郭树忠[1] 

机构地区：[1]第四军医大学西京医院整形外科,西安710032

出　　处：《中华整形外科杂志》2017年第2期112-115,共4页Chinese Journal of Plastic Surgery

摘　　要：目的 探讨术中一期修薄背阔肌、腹直肌及股薄肌肌瓣对手、足部软组织缺损进行修复的可行性.方法 2009年6月至2015年4月,应用修薄的游离肌瓣对24例手足软组织缺损患者进行修复,因肌瓣血管蒂走行于深面,我们在断蒂前或血管吻合后对肌瓣表面肌肉进行修薄,移植后取游离皮片覆盖于肌瓣表面.其中背阔肌肌瓣16例,股薄肌肌瓣4例,腹直肌肌瓣4例;手部7例,足部17例.肌瓣面积为6 cm×4 cm-20 cm×12 cm,皮片面积基本等同于肌瓣面积.结果 24例修薄肌瓣除1例因吻合口血栓导致肌瓣坏死外,其余均存活、未见明显的血运障碍和局部坏死.1例肌瓣表面皮片部分坏死,其余均成活.随访0.3 ～20个月,24例肌瓣中1例感染,1例臃肿,分别给予二次清创和修薄手术后好转,其余22例与周围组织基本齐平,外形佳,修复的足踝可正常穿鞋.结论 由于肌瓣血管蒂在深面走行且肌瓣本身血供丰富,因此术中一期进行肌瓣修薄安全可行,弥补了其臃肿的缺点,可用于手、足等部位的修复.Objective To investigate the feasibility of one-stage thinning of latissimus dorsi muscle,rectus abdominis muscle and gracilis flap in reconstruction of the hand and foot defects.Methods From June 2009 to April 2015,24 free muscle flaps were thinned during transfer operation by removing their superficial muscle layers on the basis of their vessel pedicles running in the deep surface of flaps.The surface of the muscle flaps were covered by split-thickness skin grafts.There were 16 latissimus dorsi muscle flaps,4 gracilis flaps and 4 rectus abdominis muscle flaps.Flap size ranged from 6 cm × 4 cm to 20 cm × 12 cm.Thinned muscle flaps were used to resurface 7 hand defects and 17 foot defects.Results All muscle flaps survived the thinning procedures without any circulation problems except for one case which suffered total flap necrosis due to venous thrombosis.Skins grafts on muscle flaps also took well.One patient experienced partial skin loss.Two patients underwent secondary debridement and thinning procedure for infection and bulkiness.During the 0.3-20 months follow-up,the contour of thinned muscle flaps matched well with the recipient areas.Reconstructed feet are able to wear regular shoes.Conclusions Intraoperative immediate thinning of free muscle flaps can be safely accomplished during the primary reconstruction procedure.This procedure prevents the limitations of muscle flap bulkiness and may provide an alternative for surface coverage.

关 键 词：肌瓣 修薄 缺损 修复 

分 类 号：R658[医药卫生—外科学]