胸背血管前锯肌支在胸壁缺损修复中的应用  

Application of anterior serratus branch of thoracodorsal vessel in repairing chest wall defect

作　　者：宋达疆[1] 李赞[1] 章一新[2] 周波[1] 吕春柳[1] 唐园园 易亮 罗振华 SONG Dajiang;LI Zan;ZHANG Yixin;ZHOU Bo;LÜChunliu;TANG Yuanyuan;YI Liang;LUO Zhenhua(Department of Oncology Plastic Surgery,Hunan Province 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,200011,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复外科,上海200011

出　　处：《中国修复重建外科杂志》2022年第8期1021-1025,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨胸背血管前锯肌支在胸壁缺损修复中的应用。方法 2018年10月—2021年3月,采用双侧游离下腹部皮瓣移植修复23例胸壁肿瘤术后大面积复杂缺损患者。患者均为女性;年龄23~71岁,平均48.5岁。局部晚期乳腺癌11例,叶状细胞肉瘤4例,软组织肉瘤3例,乳腺癌复发3例,胸壁放射性溃疡2例。肿瘤切除、创面清创后继发胸壁缺损范围为20 cm×10 cm~38 cm×14 cm;皮瓣切取范围25 cm×12 cm~38 cm×15 cm,血管蒂长度为9~12 cm,平均11.4 cm。14例单纯软组织缺损,采用皮瓣移植修复;5例肋骨缺损(<3根)合并软组织缺损,采用单纯网片联合皮瓣移植修复;4例胸壁全层缺损合并大范围肋骨缺损(>3根),采用“网片+骨水泥”方法坚强内固定联合皮瓣移植修复。所有患者均采用胸背血管前锯肌支作为受区血管,组合方式包括前锯肌支近心端+其他受区血管(13例)、前锯肌支近心端+远心端(6例)、2支前锯肌支近心端(4例)。结果 23例患者胸背血管主干均得以完整保留。所有患者均获随访,随访时间10~18个月,平均13.9个月。术后皮瓣完全成活,重建胸壁外形可,质地满意,无皮瓣挛缩变形;皮瓣供区仅遗留线性瘢痕,腹壁功能无明显影响。随访期间未见肿瘤复发。结论 胸背血管前锯肌支解剖恒定,对受区损伤小,可以为游离皮瓣移植修复重建胸壁提供可靠血供。Objective To investigate the application of anterior serratus branch of thoracodorsal vessel in repairing chest wall defect. Methods Between October 2018 and March 2021, bilateral free lower abdominal flaps were used to repair large-area complex defects after chest wall tumor surgery in 23 patients. The patients were all female;the age ranged from 23 to 71 years, with an average age of 48.5 years. There were 11 cases of locally advanced breast cancer,4 cases of phyllodes cell sarcoma, 3 cases of soft tissue sarcoma, 3 cases of recurrence of breast cancer, and 2 case of osteoradionecrosis. The size of secondary chest wall defect after tumor resection and wound debridement ranged from 20 cm×10 cm to 38 cm×14 cm, the size of flap ranged from 25 cm×12 cm to 38 cm×15 cm, the length of vascular pedicle was9-12 cm(mean, 11.4 cm). Fourteen cases of simple soft tissue defects were repaired by flap transplantation;5 cases of rib defects(<3 ribs) and soft tissue defects were repaired by simple mesh combined with flap transplantation;and 4 cases of full-thickness chest wall defect with large-scale rib defect(>3 ribs) were repaired by “mesh plus bone cement” rigid internal fixation combined with flap transplantation. The anterior serratus branch of thoracodorsal vessel was selected as the recipient vessel in all cases, the revascularization methods include 3 types: the proximal end of the anterior serratus branch plus other recipient vessels(13 cases), proximal and distal ends of anterior serratus branch(6 cases),and proximal ends of two anterior serratus branches(4 cases). Results The main trunk of thoracodorsal vessels was preserved completely in 23 patients. All patients were followed up 10-18 months, with an average of 13.9 months. After operation, the flap survived completely, the shape of reconstructed chest wall was good, the texture was satisfactory, and there was no flap contracture deformation. There was only a linear scar left in the flap donor site, and the abdominal wall function was not significantly aff

关 键 词：胸背血管 前锯肌支 胸壁重建 血管吻合 

分 类 号：R734.4[医药卫生—肿瘤]