摘要
目的探讨背阔肌皮瓣治疗四肢难治性创面的方法。方法自2009年12月至2016年4月,对15例四肢难治性创面患者在彻底清创的基础上采用背阔肌皮瓣修复创面,其中14例采用背阔肌游离皮瓣移植修复,1例采用带蒂背阔肌皮瓣转移修复。创面面积为11.0 cm×4.0 cm^28.0 cm×13.0 cm,切取皮瓣面积为13.0 cm×5.0 cm^30.0 cm×15.0 cm。结果本组共15例患者,其中1例术后发生血管危象,经急诊探查后皮瓣恢复血运完全成活;1例皮瓣边缘出现坏死予以换药对症治疗,见坏死界限清楚后,彻底清除坏死组织行二期游离植皮术,术后皮片成活。随访3~36个月,皮瓣全部成活,创面愈合外观较满意,受区功能恢复良好;其中6例吻合神经的感觉恢复为S3。结论采用背阔肌皮瓣修复四肢难治性创面,其皮瓣面积较大、组织厚实、血运丰富,并可根据创面需求选择肌皮瓣、肌瓣或组合皮瓣修复填充缺损部位的死腔,增强抗感染能力。该皮瓣对修复各类创伤所致的难治性创面有较明显的优势。
Objective To explore the clinical curative effect of the latissimus dorsi musculocutaneous flap in the repair of intractable wounds of the extremities. Methods From December 2009 to April 2016, the clinical data of 15 patients with intractable wounds of the extremities treated by latissimus dorsi musculocutaneous flap were analyzed retrospectively. On the basis of thorough debridement, soft tissue defects in 15 patients were repaired by latissimus dorsi musculocutaneous flap, 14 patients were treated by latissimus dorsi musculocutaneous free flap transplantation, and 1 patient was treated by pedicled latissimus dorsi musculocutaneous flap. The area of the wounds was from 11.0 cm × 4.0 cm to 28.0 cm × 13.0 cm, and the area of the flaps was from 13.0 cm × 5.0 cm to 30.0 cm × 15.0 cm.Results In 15 patients, vessel crisis occurred in one case. Blood supply was restored and the flap completely survived after emergency exploration. Another case had partial necrosis at the distal part of the flap, which healed secondarily after dressing change, thorough debridement, and free skin grafting. All patients were followed up for 3 to 36 months. All flaps survived. The appearance of wound healing was satisfactory, and the function of the recipient site was good. Sensory recovery was S3 in 6 patients with nerve anastomosis. Conclusion The latissimus dorsi musculocutaneous flap has a large area, thick tissue, and rich blood supply, which offers good wound coverage. According to the actual condition of the wounds, the musculocutaneous flap, muscle flap, or the combined flap can be selected to repair the defect sites or fill dead cavities with a strong ability to resist infection. The latissimus dorsi musculocutaneous flap has obvious advantages in the repair of intractable wounds caused by various kinds of trauma.
作者
邵志恩
巨积辉
祝伟
赵强
唐林峰
侯瑞兴
SHA0 Zhi-en;JU Ji-hui;ZHU Wei;ZHAO Qiang;TANG Lin-feng;HOU Rui-xing(Department of Hand Surgery, Ruihua Hospital Affiliated to Soochow University, Suzhou 215104, China)
出处
《中国美容整形外科杂志》
CAS
2019年第7期426-429,共4页
Chinese Journal of Aesthetic and Plastic Surgery
关键词
背阔肌皮瓣
修复
软组织缺损
难治性创面
Latissimus dorsi musculocutaneous flap
Repair
Tissue defect
Intractable wound
