背阔肌肌皮瓣及胸背动脉穿支皮瓣在不同创面中的应用

摘要

Objective To explore the application and choice of latissimus dorsi musculocutaneous flap and thoracodorsal artery perforator flap in different wound repair.Methods From March 2012 to February 2018,8 cases of different wounds were repaired with island latissimus dorsi myocutaneous flap pedicled with dorsal thoracic artery,free latissimus dorsi myocutaneous flap,or thoracodorsal artery perforator flap combined with scapular flap.The patients includes 4 cases of trauma,2 cases of tumor and 2 cases of osteomyelitis.Among them,5 cases received pedicled grafting,2 cases had anastomotic vascular free grafting combined with antibiotic bone cement chain bead,1 case had thoracodorsal artery perforator flap combined with scapular flap.Results All 9 flaps of 8 patients survived.The size of the flaps ranged from 22.0 cm×7.5 cm to 28.0 cm×21.0 cm.All the donor and recipient areas healed well.After 2 months to 2 years follow up,all flaps have good blood supply,and the limbs' function was normal.The appearance of flaps were satisfactory,with fully treated osteomyelitis,and no recurrence of the tumor was observed.Conclusions According to wound characteristics,selective application of thoracodorsal artery perforator flap,pedicled or free latissimus dorsi myocutaneous flap is effective for the repair of muscle,skin and soft tissue defects,as well as osteomyelitis,after tumor resection.%目的 探讨背阔肌肌皮瓣及胸背动脉穿支皮瓣在不同创面修复中的应用与选择.方法 2012年3月至2018年2月,湘雅常德医院整形美容烧伤科收治8例男性患者,年龄35～67岁,其中外伤4例,肿瘤2例,骨髓炎2例.创面大小20.0 cm×6.5 cm～ 26.0 cm×19.0 cm.根据创面情况选择性地应用带胸背动脉蒂的岛状背阔肌肌皮瓣、游离背阔肌肌皮瓣、胸背动脉穿支皮瓣联合肩胛皮瓣进行修复,8例中带血管蒂转移5例,吻合血管游离移植联合抗生素骨水泥珠链2例,胸背动脉穿支皮瓣联合肩胛皮瓣1例.结果 8例9块皮瓣、肌皮瓣均全部成活,皮瓣面积22.0 cm×7.5 cm～28.0 cm×21.0 cm,供区及受区愈合良好.术后随访2个月至2年,皮瓣血运及肢体功能良好,外观满意,骨髓炎得到控制,肿瘤无复发.结论 根据创面特点选择性地应用胸背动脉穿支皮瓣、带蒂或游离背阔肌肌皮瓣,可有效地修复肌肉、皮肤软组织缺损、骨髓炎、肿瘤切除后创面.