背阔肌肌皮瓣修复较大软组织缺损的方法及供区继发创面的处理  

Methods of repairing large soft tissue defect with latissimus dorsi myocutaneous flap and management of secondary wound in donor site

作　　者：马超[1] 陶然[1] 舒军 雷永红[1] 韩岩[1] Ma Chao;Tao Ran;Shu Jun;Lei Yonghong;Han Yan(Department of Plastic and Reconstructive Surgery,the First Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第一医学中心整形修复外科,北京100039

出　　处：《中华烧伤杂志》2020年第12期1199-1203,共5页Chinese Journal of Burns

摘　　要：目的探讨背阔肌肌皮瓣修复较大软组织缺损的方法以及供区继发创面的处理。方法2015年6月—2019年6月,解放军总医院第一医学中心收治各种原因所致软组织缺损或增生性瘢痕患者30例,其中男10例、女20例,年龄25~64岁,包括肿瘤生长及破溃导致头顶部软组织缺损患者18例、躯干及四肢增生性瘢痕患者7例、外伤导致面颈部软组织缺损患者5例。原发创面清创或病变组织扩大切除后面积为14 cm×10 cm^18 cm×16 cm。术前评估20例患者创面较大,进行常规单叶背阔肌肌皮瓣切取后供区无法直接拉拢缝合,遂切取面积为14 cm×5 cm^18 cm×8 cm双叶背阔肌肌皮瓣进行创面修复,供区直接拉拢缝合;术前评估10例患者进行常规单叶背阔肌肌皮瓣切取后供区可以直接拉拢缝合,切取面积为11 cm×9 cm^13 cm×10 cm单叶背阔肌肌皮瓣修复原发创面后供区张力较大,遗留面积为6 cm×4 cm^8 cm×6 cm继发创面无法直接缝合,采用面积为7 cm×4 cm^9 cm×6 cm供区局部皮瓣修复,第2供区直接拉拢缝合。术中均将背阔肌肌皮瓣中胸背动、静脉与原发受区创面的动、静脉进行端端吻合。观察术后背阔肌肌皮瓣、局部皮瓣成活情况,随访观察供受区外观及功能。结果术后所有患者移植背阔肌肌皮瓣、局部皮瓣均成活。随访6~12个月,背阔肌肌皮瓣色泽接近周围正常皮肤,质地柔软、弹性好。20例采用双叶背阔肌肌皮瓣修复的患者供区遗留线性瘢痕,其中2例患者瘢痕增生,患者均无功能障碍;10例采用单叶背阔肌肌皮瓣及供区局部皮瓣修复的患者供区外形良好,遗留线性瘢痕,形态不规则,无局部牵拉或功能障碍。结论修复较大面积软组织缺损时,术前评估后采用双叶背阔肌肌皮瓣或单叶背阔肌肌皮瓣联合供区局部皮瓣转移,在修复原发创面的同时供区可一次性闭合,术后供区瘢痕小,供受区形态、功能佳。Objective To explore the methods of repairing large soft tissue defect with latissimus dorsi myocutaneous flap and the management of secondary wound in donor site.Methods From June 2015 to June 2019,30 patients with soft tissue defect caused by various reasons or hyperplastic scar were hospitalized in the First Medical Center of Chinese PLA General Hospital,including 10 males and 20 females,aged 25-64 years,with 18 cases of head soft tissue defects caused by the growth and rupture of tumor,7 cases of hypertrophic scar in trunk and limbs,and 5 cases of facial and neck soft tissue defects caused by trauma.The area of primary wound after debridement or enlarged lesion resection was 14 cm×10 cm-18 cm×16 cm.Preoperative evaluation of 20 patients showed that the wound was relatively large,and the donor site could not be directly closed by suturing after resection of conventional single-lobe latissimus dorsi myocutaneous flap,so the bilobed latissimus dorsi myocutaneous flap with area of 14 cm×5 cm-18 cm×8 cm was cut to repair the wound,and the donor site was directly closed by suturing.Preoperative evaluation of 10 patients showed that the donor site could be directly closed by suturing after resection of conventional single-lobe latissimus dorsi myocutaneous flap,so that conventional single-lobe latissimus dorsi myocutaneous flap with area of 11 cm×9 cm-13 cm×10 cm was resected to repair the primary wound,resulting in big tension in donor site and secondary wound with area of 6 cm×4 cm-8 cm×6 cm that couldn′t be directly sutured,which was repaired with donor site local flap with area of 7 cm×4 cm-9 cm×6 cm,and the second donor site was directly closed by suturing.Intraoperative end-to-end anastomosis was performed between the thoracodorsal arteries and veins of the latissimus dorsi myocutaneous flap and the arteries and veins of the primary recipient wound.The survival of latissimus dorsi myocutaneous flaps and local flaps were observed after surgery,and the appearance and function of the donor and recipie

关 键 词：创伤和损伤 外科皮瓣 供区修复 背阔肌肌皮瓣 分叶皮瓣 局部皮瓣 

分 类 号：R644[医药卫生—外科学] R61[医药卫生—临床医学]