股外侧肌皮瓣游离移植治疗慢性顽固性脓胸的临床应用  

Clinical application of lateral femoral musculocutaneous flap free transplantation in treatment of chronic intractable empyema

作　　者：刘亦杨[1,2] 张春 郭峭峰[1] 沈立锋[3] 林炳远 马苟平[1] 黄凯[1] 张展[1] Liu Yiyang;Zhang Chun;Guo Qiaofeng;Shen Lifeng;Lin Bingyuan;Ma Gouping;Huang Kai;ZhangZhan(Department of Orthopaedics,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China;Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210008,China;Department of Orthopaedics,Sir Run Run Shaw Hospital affiliated with Zhejiang University School of Medicine,Hangzhou 310005,China)

机构地区：[1]浙江省立同德医院骨科,杭州310012 [2]南京中医药大学中西医结合鼓楼临床医学院,南京210008 [3]浙江大学医学院附属邵逸夫医院骨科,杭州310005

出　　处：《中国临床解剖学杂志》2024年第5期560-563,共4页Chinese Journal of Clinical Anatomy

基　　金：浙江省中医药科技计划项目(2024ZL035)。

摘　　要：目的报道股外侧肌皮瓣游离移植治疗慢性顽固性脓胸的疗效、优缺点及应用价值。方法回顾性分析2015年5月至2021年6月,应用股外侧肌皮瓣游离移植治疗慢性顽固性脓胸16例,男13例,女3例,年龄(51.19±17.42)岁。手术均在脓腔充分清创后,采用股外侧肌皮瓣游离移植,其中双侧股外侧肌串联移植1例,其余均为单侧。结果随访(20.94±8.27)个月,1例在术后6个月因肿瘤复发死亡。肌瓣全部成活,皮瓣部分坏死2例,清创后直接缝合。脓腔填塞良好,术后并发肺部感染1例,经支气管镜封堵胸膜瘘后治愈。患者均无胸闷等不适。下肢供瓣区均直接缝合,愈合良好,行走及膝关节活动无明显影响。结论股外侧肌血管恒定,解剖清楚,肌肉形态长而宽且体积较大,能够有效填塞脓胸形成的空腔并闭合创口。这一术式不仅拓宽了股外侧肌皮瓣的应用范围,还为顽固性脓胸的治疗提供了新的选择。Objective To investigate the efficacy,advantages,disadvantages and application value of lateral femoral musculocutaneous flap free transplantation in the treatment of chronic refractory empyema.Methods From May 2015 to June 2021,16 cases(including 13 males and 3 females)aged(51.19±17.42)years of chronic refractory empyema were treated with lateral femoral musculocutaneous flap free transplantation.The lateral femoral musculocutaneous flap was transplanted after full debridement of pus cavity.In 1 case,the lateral femoral muscle was transplanted in two sides,and the rest were transplanted in one side.Results During the follow-up of(20.94±8.27)months,1 case died of tumor recurrence 6 months after operation,all the muscle flaps survived,and 2 cases of partial skin-flap necrosis were sutured directly after debridement.The abscess cavity was well filled in all cases.Postoperative pulmonary infection occurred in 1 case,which was cured after bronchoscopic closure of pleural fistula.None of the patients had symptoms such as chest tightness.The donor areas of the lower limb muscle flap were sutured directly and healed well.Walking function and knee joint activity were not significantly affected.Conclusions The lateral femoral muscle has constant blood vessels,clear anatomy,long and wide muscle shape and large volume,which can effectively fill the cavity formed by empyema and close the wound.This operation not only broadens the application range of lateral femoral musculocutaneous flap,but also provides a new choice for the treatment of intractable empyema.

关 键 词：股外侧肌 肌皮瓣 脓胸 显微外科技术 

分 类 号：R616.2[医药卫生—外科学] R625.2[医药卫生—临床医学]