背阔肌皮瓣移植治疗乳腺癌改良根治术后胸壁顽固性放射性溃疡的效果分析  

Treatment of Refractory Chest Radiation Ulcer by Latissimus Dorsi Flap

作　　者：郑立武 周树萍 李士民 Zheng Liwu;Zhou Shuping;Li Shimin(Department of burn and plastic surgery,the 988th Hospital of the Joint Logistics Support Force of PLA.Zhengzhou 450052,China)

机构地区：[1]中国人民解放军联勤保障部队第九八八医院烧伤整形科,郑州450052

出　　处：《河南外科学杂志》2023年第6期22-24,共3页Henan Journal of Surgery

摘　　要：目的探讨背阔肌皮瓣移植治疗乳腺癌改良根治术后胸壁顽固性放射性溃疡的临床效果。方法回顾性分析2010-01—2021-01中国人民解放军联勤保障部队第九八八医院烧伤整形科收治的15例乳腺癌改良根治术后胸壁顽固性放射性溃疡患者的临床资料。年龄(55±1)岁(范围:47~68岁),溃疡面积(10 cm×5 cm±5 cm×1 cm)(范围:5 cm×4 cm~15 cm×6 cm)。病程(2±0.5)a(1.25~5 a)。15例均伴有胸肋骨外露及骨坏死、骨髓炎。术后随访12~18个月,记录皮瓣成活情况、供皮区创面愈合情况,以及随访期间的溃疡复发情况。末次随访参考温哥华瘢痕评定量表(VSS)评分评价皮瓣质量。结果本组15例患者的皮瓣术后全部成活,1例脂肪液化,换药10 d后给予扩创、缝合后愈合,供区6例行直接缝合,9例移植全厚皮,均甲级愈合。随访期间均无复发病例。末次随访,皮瓣VSS评分(3.26±0.12)分(范围:2~4分)。结论背阔肌皮瓣穿支恒定,血运丰富,切取相对简单,并可携带肌肉,是治疗乳腺癌改良根治术后胸壁顽固性放射性溃疡的有效手段。Objective To investigate the efficacy of the latissimus dorsi flap to treat the refractory chest radiation ulcer.Methods From January 2010 to January 2021,15 patients with the refractory chest radiation ulcer after breast cancer surgery were cured by latissimus dorsi flap.The 15 patients were accompanied by osteonecrosis and osteomyelitis of sternum exposure or ribs exposure.All the patients were followed up for 12 to 18 months after surgery.The survival of the flap,the healing of the donor site wounds,and the recurrence of ulcers during the follow-up period were recorded.The final follow-up was evaluated based on the Vancouver Scar Rating Scale(VSS)score to evaluate the quality of the flap.Results All the flaps were survival at last,and 14 cases healed without infection and vascular crisis,1case healed after the second expansion.Conclusion The latissimus dorsi flap has constant perforating branches,abundant blood supply,and the surgical removal of flap is relatively simple,and can carry muscles.It has a good effect in the treatment of chest radiation ulcers,and is worthy of clinical application.

关 键 词：背阔肌皮瓣 胸部 放射性溃疡 创面修复 

分 类 号：R625.2[医药卫生—整形外科]