摘要
目的探讨功能性胸背动脉穿支皮瓣(TDAPF)嵌合背阔肌游离移植重建前臂动力肌和软组织缺损的临床技术与效果。方法2014年1月至2020年12月,宁波市第六医院手外科、整复外科择期游离移植嵌合背阔肌的功能性TDAPF重建前臂复合组织缺损共13例(男12例、女1例),平均年龄33.2岁。本组均为前臂开放伤,左侧5例,右侧8例。急诊行失活肌肉清除加血管、神经探查修复和创面VSD处理。重建手术在伤后4~12 d,平均7.5 d内完成,缺损面积为9.0 cm×8.0 cm~21.0 cm×11.0 cm,皮瓣切取面积为10.0 cm×9.0 cm~22.0 cm×12.0 cm,嵌合的功能性肌瓣体积为9.0 cm×2.0 cm×1.5 cm~19.0 cm×9.0 cm×1.5 cm,重建指深屈肌4例,指总伸肌8例,桡侧腕屈肌3例,拇长屈肌1例,其中用1块背阔肌的2个功能亚单位分别重建桡侧腕屈肌和指总伸肌3例。皮瓣供区直接缝合关闭。后期通过门诊或电话随访患者,评估皮瓣外观、手指活动范围、肌力恢复和手部握力等情况。结果术后12例组织瓣一期顺利成活,另1例出现静脉危象,经手术探查后成活。术后随访17~52个月,平均34.1个月。肢体和皮瓣外形美观,无明显臃肿、色素沉着及瘢痕挛缩。4例重建屈指的肌力恢复均为M_(4),握拳时指端距离掌心小于2.0 cm,平均手部握力达到健侧的27.5%(20%~35%);5例单独重建伸指的肌力恢复M_(4),手指屈、伸范围无明显受限,平均手部握力达到健侧的75.4%(65%~80%);在同时重建2种动力肌的3例患者中,桡侧腕屈的肌力恢复均为M_(4),伸指肌力恢复M_(4)1例、M_(3)2例;1例重建屈拇的肌力无明显恢复。结论功能性TDAPF同时具备穿支皮瓣和功能性肌肉移植的优势,不仅可满足复杂创面覆盖的需求,而且还能精准、可靠地重建前臂毁损肌群,恢复前臂外形和手部活动功能。
ObjectiveTo explore the surgical techniques and effects of transfer of the free chimeric functional thoracodorsal artery perforator flap(TDAPF)with latissimus dorsi in reconstruction of dynamic muscle and soft tissue defects in forearm.MethodsFrom January 2014 to December 2020,a total of 13 transfer surgery of free chimeric functional TDAPF with vascularised latissimus dorsi were performed in the Department of Hand Surgery,Plastic&Reconstructive Surgery,Ningbo Sixth Hospital,to reconstruct forearm composite defects.The patients were 12 males and 1 female with an average age of 33.2 years old.They all had open forearm injuries,with 5 in the left and 8 in the right.Removal of inactivated muscles,exploration and repair of blood vessels and nerves were performed in emergency surgery,and VSD were applied after the surgery.Phase II reconstructive surgery were completed within 4 to 12 days,with 7.5 days in average.The wounds and flaps sized were 9.0 cm×8.0 cm-21.0 cm×11.0 cm and were 10.0 cm×9.0 cm-22.0 cm×12.0 cm,respectively.The volume of transferred muscles ranged were 9.0 cm×2.0 cm×1.5 cm-19.0 cm×9.0 cm×1.5 cm.Free chimeric functional muscular flaps were transferred to reconstruct the musculus flexor digitorum profundus in 4 patients,the musculus extensor digitorum communis in 8 patients,the musculus flexor carpi radialis in 3 patients,and the musculus flexor pollicis longus in 1 patient.Reconstruction of both of musculus flexor carpi radialis and musculus extensor digitorum communis with 2 functional sub-blocks of latissimus dorsi were performed in 3 patients.All donor sites were closed primarily.All patients were included in the postoperative follow-up to evaluate the appearance of flaps,range of motion of the digits,recovery of muscle strength and gripping power,at the outpatient clinics or through the telephone interview.ResultsA total of 12 flaps survived uneventfully after reconstructive surgery.One flap developed a vascular crisis and it was rectified after surgical exploration.Postoperative follow-up
作者
潘佳栋
王欣
尹善青
黄耀鹏
沈依俊
俞高翔
郭浩
肖栋超
PAN Jiadong;WANG Xin;YIN Shanqing;HUANG Yaopeng;SHEN Yijun;YU Gaoxiang;GUO Hao;XIAO Dongchao(Department of Hand Surgery,Plastic&Reconstructive Surgery,Ningbo Sixth Hospital,Ningbo,Zhejiang Province 315040,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2024年第3期241-247,共7页
Chinese Journal of Microsurgery
基金
宁波市重点研发计划暨“揭榜挂帅”项目(2022Z146)
宁波市医疗卫生高端团队重大攻坚项目(2022020506)。
关键词
胸背动脉穿支皮瓣
背阔肌肌瓣
功能性肌肉移植
前臂
外伤性肌肉缺损
嵌合皮瓣
Thoracodorsal artery perforator flap
Latissimus dorsi muscle flap
Functional muscle transfer
Forearm
Traumatic muscle defect
Chimeric flap
