分叶带蒂腹直肌皮瓣修复巨大胸壁缺损的疗效观察  

Effectiveness of lobulated pedicled rectus abdominis myocutaneous flap for repairing huge chest wall defect

作　　者：宋达疆[1] 李赞[1] 章一新[2] SONG Dajiang;LI Zan;ZHANG Yixin(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,20001l,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200011

出　　处：《中国修复重建外科杂志》2023年第4期473-477,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨分叶带蒂腹直肌皮瓣修复巨大胸壁缺损的疗效。方法2021年6月—2022年6月,采用分叶带蒂腹直肌皮瓣修复14例巨大胸壁缺损患者。男5例,女9例;年龄32~57岁,平均44.2岁。左侧8例,右侧6例。晚期乳腺癌5例,胸壁原发肿瘤5例,乳腺癌术后胸壁放射性骨坏死4例。胸壁软组织缺损范围为20 cm×16 cm~22 cm×22 cm。切取大小为26 cm×8 cm~35 cm×14 cm的双侧带蒂腹直肌皮瓣,根据胸壁缺损面积将其制备成面积基本相等的两个皮岛,转移至胸壁缺损区域后重新拼接,具体方式:7例低位对侧皮岛位置不变、高位同侧皮岛旋转90°,7例两侧皮岛均分别旋转90°后重新拼接。供区直接拉拢缝合。结果术后14例皮瓣全部顺利成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合。患者均获随访,随访时间6~12个月,平均8.7个月。皮瓣外观、质地满意。供区仅遗留线性瘢痕,腹壁外观及活动无影响。所有肿瘤患者均未见局部复发;2例乳腺癌患者发生远处转移。结论灵活设计并切取分叶带蒂腹直肌皮瓣可以最大程度确保皮瓣血运,充分利用皮瓣组织修复巨大胸壁缺损后可减少术后并发症的发生。Objectivee To explore the effectiveness of lobulated pedicled rectus abdominis myocutaneous flap to repair huge chest wall defect.MethodsBetween June 2021 and June 2022,14 patients with huge chest wall defects were treated with radical resection of the lesion and lobulated pedicled rectus abdominis myocutaneous flap transplantation for reconstruction of chest wall defects.The patients included 5 males and 9 females with an average age of 44.2 years(range,32-57 years).The size of skin and soft tissue defect ranged from 20 cm×16 cm to 22 cm×22 cm.The bilateral pedicled rectus abdominis myocutaneous flaps in size of 26 cmx8 cm to 35 cmx14 cm were prepaired and cut into two skin paddles with basically equal area according to the actual defect size of the chest wall.After the lobulated pedicled rectus abdominis myocutaneous flap was transferred to the defect,there were two reshaping methods.The first method was that the skin paddle at the lower position and opposite side was unchanged,and the skin paddle at the effected side was rotated by 90°(7 cases).The second method was that the two skin paddles were rotated 90°respectively(7 cases).The donor site was sutured directly.ResultsAll 14 flaps survived successfully and the wound healed by first intention.The incisions at donor site healed by first intention.All patients were followed up 6-12 months(mean,8.7 months).The appearance and texture of the flaps were satisfactory.Only linear scar was left at the donor site,and the appearance and activity of the abdominal wall were not affected.No local recurrence was found in all tumor patients,and distant metastasis occurred in 2 breast cancer patients(1 liver metastasis and 1 lung metastasis).Conclusion The lobulated pedicled rectus abdominis myocutaneous flap in repair of huge chest wall defect can ensure the safety of blood supply of the flap to the greatest extent,ensure the effective and full use of the flap tissue,and reduce postoperative complications.

关 键 词：巨大胸壁缺损 腹直肌皮瓣 胸壁重建 分叶皮瓣 

分 类 号：R655.1[医药卫生—外科学]