组合组织瓣移植修复巨大胸壁缺损的临床效果  

Clinical effects of combined tissue flap transplantation for repairing giant chest wall defects

作　　者：于峻懿 宋达疆[1] 刘旭 王志远[2] 李赞[1] 章一新[3] 周波[1] 吕春柳[1] 唐园园 易亮 罗振华 杨丽仪 Yu Junyi;Song Dajiang;Liu Xu;Wang Zhiyuan;Li Zan;Zhang Yixin;Zhou Bo;Lyu Chunliu;Tang Yuanyuan;Yi Liang;Luo Zhenhua;Yang Liyi(Department of Breast Oncoplastic Surgery,Hunan Cancer Hospital,Changsha 410008,China;Ultrasonic Diagnostic Center,Hunan Cancer Hospital,Changsha 410008,China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Breast and Thyroid Surgery,Jiangyin People's Hospital,Jiangyin 214400,China)

机构地区：[1]湖南省肿瘤医院乳腺肿瘤整形外科,长沙410008 [2]湖南省肿瘤医院超声诊断中心,长沙410008 [3]上海交通大学医学院附属第九人民医院整复外科,上海200011 [4]江阴市人民医院乳腺甲状腺外科,江阴214400

出　　处：《中华烧伤与创面修复杂志》2024年第7期650-656,共7页Chinese Journal of Burns And Wounds

基　　金：湖南省卫生健康委员会科研项目(202209024847);湖南省自然科学基金科卫联合项目(2023JJ60334)。

摘　　要：目的探讨组合组织瓣移植修复巨大胸壁缺损的临床效果。方法该研究为回顾性观察性研究。2013年8月-2020年12月,湖南省肿瘤医院乳腺肿瘤整形外科收治31例符合入选标准的胸壁肿瘤或胸壁肿瘤根治术后放射性溃疡患者,其中男12例、女19例,年龄25~71岁。行肿瘤/溃疡切除、创面清创后,继发胸壁缺损面积为300~600 cm 2(长16~35 cm、宽16~32 cm)。按照患者的实际情况及术前设计,灵活采用不同供区穿支皮瓣、肌皮瓣组合修复胸壁缺损,组合组织瓣面积260~540 cm^(2)(长20~30 cm、宽13~20 cm),其中2例患者采用游离大腿后内侧穿支皮瓣+游离股前外侧肌皮瓣,5例患者采用游离腹壁下动脉穿支皮瓣+游离股前外侧肌皮瓣,7例患者采用游离腹壁下动脉穿支皮瓣+带蒂腹直肌肌皮瓣+游离股前外侧肌皮瓣,2例患者采用游离腹壁下动脉穿支皮瓣+带蒂腹直肌肌皮瓣+带蒂背阔肌肌皮瓣,15例患者采用双侧游离股前外侧肌皮瓣。对于组合组织瓣修复后剩余的小面积浅表组织缺损,采用皮片移植修复或于组织瓣成活、组织水肿消退后行延期局部皮瓣转移修复,选择合适的供受区血管进行吻合以重建组织瓣血运。将能直接缝合的组织瓣供区创面直接缝合,不能直接缝合者行皮片移植或延期缝合。记录受区血管吻合情况、手术耗时、术后住院天数。术后观察组织瓣、皮片成活情况,重建的胸壁外形和质地,组织瓣供区创面愈合情况、瘢痕形成情况、功能情况,供皮区瘢痕形成情况。术后随访肿瘤复发情况及复发患者死亡情况。结果受区吻合血管如下:胸廓内血管近心端24次、远心端12次,胸背血管主干4次,胸背血管前锯肌支8次,胸肩峰血管12次。手术耗时为6.0~8.5 h,术后住院天数为9~21 d。4例患者术后部分组织瓣边缘坏死,均采用换药处理后愈合;其余患者组织瓣及移植皮片均完全成活。重建的胸壁外形、质Objective To investigate the clinical effects of combined tissue flap transplantation in repairing giant chest wall defects.Methods This study was a retrospective observational study.From August 2013 to December 2020,31 patients with chest wall tumor or radiation ulcer after radical resection of chest wall tumor and conformed to the inclusion criteria were admitted to the Department of Breast Oncoplastic Surgery of Hunan Cancer Hospital,including 12 males and 19 females,aged 25-71 years.After resection of tumor or ulcer and wound debridement,the area of secondary chest wall defect was 300-600 cm^(2) with length of 16-35 cm and width of 16-32 cm.According to the actual situation of the patients and the preoperative design,the chest wall defects were repaired with the flexible combination of perforator flaps and myocutaneous flaps from different donor sites,and the area of the combined tissue flap was 260-540 cm 2 with length of 20-30 cm and width of 13-20 cm.Free posteromedial thigh perforator flap+free anterolateral thigh myocutaneous flap were used in 2 patients,free deep inferior epigastric artery perforator flap+free anterolateral thigh myocutaneous flap were used in 5 patients,free deep inferior epigastric artery perforator flap+pedicled rectus abdominis myocutaneous flap+free anterolateral thigh myocutaneous flap were used in 7 patients,free deep inferior epigastric artery perforator flap+pedicled rectus abdominis myocutaneous flap+pedicled latissimus dorsi myocutaneous flap were used in 2 patients,and bilateral free anterolateral thigh myocutaneous flaps were used in 15 patients.For the remaining small area of superficial tissue defect after being repaired by combined tissue flaps,skin graft was used to repair or delayed local flap transfering was performed after the tissue flaps survived and edema subsided.The appropriate blood vessels in the donor and recipient sites were selected for anastomosis to reconstruct the blood supply of tissue flaps.The wounds in the donor sites of tissue flaps that can be dire

关 键 词：穿支皮瓣 肌皮瓣 胸壁 肿瘤 创面修复 

分 类 号：R734.4[医药卫生—肿瘤]