胸背动脉穿支皮瓣在肩胸背部创面修复中的临床应用  

Clinical application of thoracodorsal artery perforator flap in the repair of shoulders,chest and back wounds

作　　者：李承龙[1] 仲海燕 陈勇[1] 王倩[1] 邹鸣立 袁斯明 LI Chenglong;ZHONG Haiyan;CHEN Yong;WANG Qian;ZOU Mingli;YUAN Siming(Department of Burn and Plastic Surgery,Jinling Hospital,Nanjing Medical University,Nanjing 210002,China)

机构地区：[1]南京医科大学附属金陵医院(中国人民解放军东部战区总医院)烧伤整形科,江苏省南京市210002

出　　处：《组织工程与重建外科》2024年第1期64-68,共5页Journal of Tissue Engineering and Reconstructive Surgery

基　　金：东部战区总医院院内课题(YYZD2021001)。

摘　　要：目的探讨胸背动脉穿支皮瓣在肩胸背部皮肤软组织缺损修复中的应用。方法自2019年1月至2022年12月,应用胸背动脉穿支皮瓣修复肩胸背部皮肤软组织缺损8例,致伤原因均为肿瘤切除术后。术前应用CTA和手持多普勒超声确认胸背动脉的存在、走行、分支及穿支位置。根据创面位置、面积设计胸背动脉穿支皮瓣。皮瓣仅携带穿支发出位置的极少量肌肉,将胸背动脉降支近端从肌肉内剥离,保留胸背动脉横支和胸背神经。如血管蒂长度不足,可切断横支。皮瓣带蒂转移修复创面。供瓣区拉拢缝合。结果8例皮瓣均存活,供瓣区切口愈合好。随访6个月到2年,所有患者受区外观满意,供瓣区无明显畸形,肩关节功能无明显影响。结论胸背动脉穿支皮瓣血供可靠,血管蒂长,且基本完整地保留了背阔肌功能,是修复肩胸背部邻近创面的良好选择。Objective To explore the application of thoracodorsal artery perforator flap in the repair of shoulders,chest and back skin soft tissue defects.Methods From January 2019 to December 2022,thoracodorsal artery perforator flap was applied to repair skin soft tissue defects of shoulder,chest and back in a total of 8 cases,all of which were caused by tumor resection.Preoperatively,CTA and handheld Doppler ultrasound were applied to confirm the presence,course,branches,and location of the thoracodorsal artery.The thoracodorsal artery perforator flap was designed according to the location and area of the vulnus.The flap carried only a very small piece of muscle in the location where the perforating branch emanated,and the proximal descending branch of the thoracodorsal artery was stripped from the muscle,preserving the transverse branch of the thoracodorsal artery and the thoracodorsal nerve.The transverse branch could be cut if the length of the vascular pedicle was insufficient.The flap was transferred with the pedicle to repair the wound.The donor area was sutured by pulling together.Results The flap survived in all 8 cases,and the incision in the donor area healed well.The patients were followed up for 6 months to 2 years.All patients were satisfied with the appearance of the recipient area,and there was no obvious deformity in the donor area,and the function of the shoulder joint was not significantly affected.Conclusion The thoracodorsal artery perforator flap has a reliable blood supply,a long vascular pedicle,and preserves the function of the latissimus dorsi muscle,which makes it a good choice for repairing wounds adjacent to the shoulders,chest and back.

关 键 词：胸背动脉穿支皮瓣 皮肤软组织缺损 肩胸背部 背阔肌 

分 类 号：R622[医药卫生—整形外科]