肋间动脉增压超长背阔肌皮瓣修复四肢创面
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摘要
目的探讨肋间动脉增压超长背阔肌皮瓣修复四肢创面的疗效。方法 2016年1月—2017年12月,采用肋间动脉增压超长背阔肌皮瓣修复四肢软组织缺损5例。男4例,女1例,年龄43～59岁,平均45.8岁。受伤至皮瓣修复时间为7～25 d,平均12.3 d。致伤原因:机器绞伤2例,交通事故伤2例,机器挤压伤1例。创面位于上肢前侧3例、后侧1例,小腿后侧1例。创面范围为26 cm×8 cm～38 cm×10 cm。背阔肌皮瓣切取范围为36 cm×6 cm～43 cm×7 cm,肌瓣切取范围为36 cm×10 cm～43 cm×15 cm。供区均直接拉拢缝合。结果术后1例背阔肌皮瓣远端坏死,经对症处理后愈合;其余4例皮瓣完全成活,创面均Ⅰ期愈合。供区切口均Ⅰ期愈合。5例患者均获随访,随访时间8～18个月,平均14.9个月。皮瓣外形满意、质地柔软,有排汗功能。结论肋间动脉增压超长背阔肌皮瓣修复四肢创面能减少皮瓣远端坏死并发症的发生,取得满意临床疗效。
Objective To explore the clinical application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair. Methods Between January 2016 and December 2017,5 patients with limb wounds were treated with the extra-long latissimus dorsi flaps. The vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery was applied during the operation. There were 4 males and1 female, with an average age of 45.8 years(range, 43-59 years). The time from post-traumatic admission to flap repair was 7-25 days(mean, 12.3 days). The causes of injury included machine injury in 2 cases, traffic accident in 2 cases, and roller crush injury in 1 case. The wounds were located at the anterior of upper limb in 3 cases, the posterior of upper limb in1 case, and the posterior of leg in 1 case. The size of wounds ranged from 26 cm×8 cm to 38 cm×10 cm. The size of the latissimus dorsi flap ranged from 36 cm×6 cm to 43 cm×7 cm. The size of the muscle flap ranged from 36 cm×10 cm to 43 cm×15 cm. The donor sites were closed directly. Results The distal flap necrosis occurred in 1 case and healed after symptomatically treatment. The other flaps survived completely. The wounds and incisions at donor sites healed by first intention. All patients were followed up 8-18 months with an average of 14.9 months. At last follow-up, the flaps had satisfactory appearances, soft textures, and function of sweating. Conclusion Application of vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery in repair of limb wound can reduce the incidence of distal flap necrosis and achieve satisfactory effectiveness.
Objective To explore the clinical application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair. Methods Between January 2016 and December 2017,5 patients with limb wounds were treated with the extra-long latissimus dorsi flaps. The vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery was applied during the operation. There were 4 males and1 female, with an average age of 45.8 years(range, 43-59 years). The time from post-traumatic admission to flap repair was 7-25 days(mean, 12.3 days). The causes of injury included machine injury in 2 cases, traffic accident in 2 cases, and roller crush injury in 1 case. The wounds were located at the anterior of upper limb in 3 cases, the posterior of upper limb in1 case, and the posterior of leg in 1 case. The size of wounds ranged from 26 cm×8 cm to 38 cm×10 cm. The size of the latissimus dorsi flap ranged from 36 cm×6 cm to 43 cm×7 cm. The size of the muscle flap ranged from 36 cm×10 cm to 43 cm×15 cm. The donor sites were closed directly. Results The distal flap necrosis occurred in 1 case and healed after symptomatically treatment. The other flaps survived completely. The wounds and incisions at donor sites healed by first intention. All patients were followed up 8-18 months with an average of 14.9 months. At last follow-up, the flaps had satisfactory appearances, soft textures, and function of sweating. Conclusion Application of vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery in repair of limb wound can reduce the incidence of distal flap necrosis and achieve satisfactory effectiveness.
引文
1刘昌雄,唐举玉,刘鸣江,等.背阔肌皮瓣游离移植修复小儿四肢远端巨大软组织缺损.中华显微外科杂志,2010,33(4):350.
2沈勇,王彦生,林涧,等.应用游离背阔肌皮瓣治疗四肢软组织缺损.中华显微外科杂志,2012,35(6):516.
3潘小平,许祥明,郑功胜.背阔肌皮瓣游离移植修复下肢软组织缺损的临床分析.中华显微外科杂志,2010,33(5):402-403.
4李黎明,李桂石,林峰,等.胸背动脉前锯肌支为蒂逆行背阔肌皮瓣的临床应用.中华显微外科杂志,2010,33(5):401-402.
5刘志远,唐修俊,王达利,等.背阔肌Kiss皮瓣修复上臂复合组织缺损及功能重建.中国修复重建外科杂志,2017,31(9):1106-1110.
6Dennis M,Granger A,Ortiz A,et al.The anatomy of the musculocutaneous latissimus dorsi flap for neophalloplasty.Clin Anat,2018,31(2):152-159.
7杨林,刘宏君,张文忠,等.改良股前外侧游离穿支皮瓣桥式交叉移植修复小腿中下段软组织缺损.中国修复重建外科杂志,2017,31(10):1240-1244.
8李海,邓呈亮,魏在荣,等.分叶股前外侧穿支皮瓣在血管蒂保护中的作用研究.中国修复重建外科杂志,2017,31(10):1245-1249.
9宋达疆,李赞,周晓,等.股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床应用.中国修复重建外科杂志,2017,31(1):52-56.
10唐举玉,李康华,刘俊,等.背阔肌皮瓣游离移植修复下肢巨大软组织缺损.中国修复重建外科杂志,2006,20(11):1087-1089.
11Watanabe K,Kiyokawa K,Rikimaru H,et al.Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution.JPlast Reconstr Aesthet Surg,2010,63(7):1091-1098.
12Branford OA,Kelemen N,Hartmann CE,et al.Subfascial harvest of the extended latissimus dorsi myocutaneous flap in breast reconstruction:a comparative analysis of two techniques.Plast Reconstr Surg,2013,132(4):737-48.
13Takagi S,Oyama T,Yamazumi K,et al.Vascular augmentation of an extended latissimus dorsi myocutaneous flap through an intercostal vessel:a preliminary report.J Plast Surg Hand Surg,2013,47(2):123-125.
14Hokin JA.Mastectomy reconstruction without a prosthetic implant.Plast Reconstr Surg,1983,72(6):810-818.
15Papp C,McCraw JB.Autogenous latissimus breast reconstruction.Clin Plast Surg,1998,25(2):261-266.
16Germann G,Steinau HU.Breast reconstruction with the extended latissimus dorsi flap.Plast Reconstr Surg,1996,97(3):519-526.
17Chang DW,Youssef A,Cha S,et al.Autologous breast reconstruction with the extended latissimus dorsi flap.Plast Reconstr Surg,2002,110(3):751-761.
18Kim CY,Kim YH.Supermicrosurgical reconstruction of large defects on ischemic extremities using supercharging techniques on latissimus dorsi perforator flaps.Plast Reconstr Surg,2012,130(1):135-144.
2沈勇,王彦生,林涧,等.应用游离背阔肌皮瓣治疗四肢软组织缺损.中华显微外科杂志,2012,35(6):516.
3潘小平,许祥明,郑功胜.背阔肌皮瓣游离移植修复下肢软组织缺损的临床分析.中华显微外科杂志,2010,33(5):402-403.
4李黎明,李桂石,林峰,等.胸背动脉前锯肌支为蒂逆行背阔肌皮瓣的临床应用.中华显微外科杂志,2010,33(5):401-402.
5刘志远,唐修俊,王达利,等.背阔肌Kiss皮瓣修复上臂复合组织缺损及功能重建.中国修复重建外科杂志,2017,31(9):1106-1110.
6Dennis M,Granger A,Ortiz A,et al.The anatomy of the musculocutaneous latissimus dorsi flap for neophalloplasty.Clin Anat,2018,31(2):152-159.
7杨林,刘宏君,张文忠,等.改良股前外侧游离穿支皮瓣桥式交叉移植修复小腿中下段软组织缺损.中国修复重建外科杂志,2017,31(10):1240-1244.
8李海,邓呈亮,魏在荣,等.分叶股前外侧穿支皮瓣在血管蒂保护中的作用研究.中国修复重建外科杂志,2017,31(10):1245-1249.
9宋达疆,李赞,周晓,等.股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床应用.中国修复重建外科杂志,2017,31(1):52-56.
10唐举玉,李康华,刘俊,等.背阔肌皮瓣游离移植修复下肢巨大软组织缺损.中国修复重建外科杂志,2006,20(11):1087-1089.
11Watanabe K,Kiyokawa K,Rikimaru H,et al.Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution.JPlast Reconstr Aesthet Surg,2010,63(7):1091-1098.
12Branford OA,Kelemen N,Hartmann CE,et al.Subfascial harvest of the extended latissimus dorsi myocutaneous flap in breast reconstruction:a comparative analysis of two techniques.Plast Reconstr Surg,2013,132(4):737-48.
13Takagi S,Oyama T,Yamazumi K,et al.Vascular augmentation of an extended latissimus dorsi myocutaneous flap through an intercostal vessel:a preliminary report.J Plast Surg Hand Surg,2013,47(2):123-125.
14Hokin JA.Mastectomy reconstruction without a prosthetic implant.Plast Reconstr Surg,1983,72(6):810-818.
15Papp C,McCraw JB.Autogenous latissimus breast reconstruction.Clin Plast Surg,1998,25(2):261-266.
16Germann G,Steinau HU.Breast reconstruction with the extended latissimus dorsi flap.Plast Reconstr Surg,1996,97(3):519-526.
17Chang DW,Youssef A,Cha S,et al.Autologous breast reconstruction with the extended latissimus dorsi flap.Plast Reconstr Surg,2002,110(3):751-761.
18Kim CY,Kim YH.Supermicrosurgical reconstruction of large defects on ischemic extremities using supercharging techniques on latissimus dorsi perforator flaps.Plast Reconstr Surg,2012,130(1):135-144.