带蒂股前外侧肌皮瓣修复腹壁肿瘤术后全层缺损  

Application of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection

作　　者：宋达疆[1] 李赞[1] 周晓[1] 章一新[2] 彭小伟[1] 周波[1] 吕春柳[1] SONG Dajiang;LI Zan;ZHOU Xiao;ZHANG Yixin;PENG Xiaowei;ZHOU Bo;LU Chunliu(Department of Oncology Plastic Surgery,Hunan Cancer Hospital,Changsha Hunan,410008,P.R.China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200000,P.R.China)

机构地区：[1]湖南省肿瘤医院肿瘤整形外科,长沙410008 [2]上海交通大学医学院附属第九人民医院整形外科,上海200000

出　　处：《中国修复重建外科杂志》2019年第6期712-716,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：湖南省自然科学基金面上项目(2018JJ2241、2018JJ2242);湖南省科技计划项目(2014SK3002);湖南省医药卫生科研计划课题项目(B2014-111);湖南省肿瘤整形外科临床医学研究中心平台建设专项资助(2013TP4087)~~

摘　　要：目的探讨带蒂股前外侧肌皮瓣修复腹壁肿瘤术后全层缺损的疗效。方法 2010年9月-2017年12月,收治18例腹壁肿瘤患者。男11例,女7例;年龄29~68岁,平均45.2岁。原发疾病:腹壁纤维瘤8例,肉瘤6例,结肠腺癌腹壁转移2例,恶性畸胎瘤2例。手术彻底切除肿瘤,遗留全层腹壁缺损范围为15 cm×6 cm^25 cm×22 cm;采用网片固定重建腹膜连续性,带蒂股前外侧肌皮瓣填充腔隙及修复皮肤软组织缺损;其中股外侧肌瓣切取范围为10 cm×8 cm^22 cm×10 cm,股前外侧皮瓣为14.0 cm×8.0 cm^21.0 cm×8.5 cm。其中2例大面积缺损采用双侧带蒂股前外侧肌皮瓣修复。供区均直接拉拢缝合。结果术后所有皮瓣顺利成活,创面Ⅰ期愈合;供区切口Ⅰ期愈合。患者均获随访,随访时间11~56个月,平均22.5个月。随访期间均无肿瘤复发,未见腹壁疝表现,皮瓣外观及腹部功能均满意。结论带蒂股前外侧肌皮瓣结合网片适用于修复腹壁肿瘤术后全层缺损。Objective To explore the effectiveness of pedicled anterolateral thigh myocutaneous flap for fullthickness abdominal wall reconstruction after tumor resection. Methods Between September 2010 and December 2017,18 patients with abdominal wall tumors were collected. There were 11 males and 7 females, with an average age of 45.2 years(range, 29-68 years). Histologic diagnosis included desmoid tumor in 8 cases, sarcomas in 6 cases, malignant teratoma in 2 cases, and colon adenocarcinoma in 2 cases. All abdominal wall defects were full-thickness defects.Peritoneum continuity was reconstructed with mesh;the lateral vastus muscular flaps were used to fill the dead space and rebuild the abdominal wall strength;the abdominal wall soft tissue defects were repaired with pedicled anterolateral thigh flaps. The size of abdominal wall defects ranged from 15 cm×6 cm to 25 cm×22 cm;the size of lateral vastus muscular flap ranged from 10 cm×8 cm to 22 cm×10 cm;the size of anterolateral thigh flap ranged from 14.0 cm×8.0 cm to 21.0 cm×8.5 cm. The bilateral pedicled anterolateral thigh myocutaneous flaps were harvested to repair the extensive abdominal wall defects in 2 cases. All donor sites were sutured directly. Results All wounds healed smoothly and all flaps survived totally. All donor sites healed smoothly. The mean follow-up time was 22.5 months(range, 11-56 months). No tumor recurrence occurred, the abdominal function and appearance were satisfactory, no abdominal hernia was noted. Only linear scar left at the donor sites. Conclusion Pedicled anterolateral thigh myocutaneous flap combined with mesh is fit for large full-thickness abdominal defect reconstruction.

关 键 词：腹壁缺损 股前外侧肌皮瓣 带蒂皮瓣 腹壁肿瘤 创面修复 

分 类 号：R622[医药卫生—整形外科]