中国修复重建外科杂志

中国修复重建外科杂志

肋间动脉增压超长背阔肌皮瓣修复四肢创面

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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 and 1 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 in 1 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.

关键词: 背阔肌皮瓣; 超长皮瓣; 肋间动脉; 四肢创面

Key words: Latissimus dorsi flap; extra-long flap; intercostal artery; limb wound

引用本文: 惠涛涛, 黎逢峰, 吴永伟, 刘军, 马运宏, 芮永军. 肋间动脉增压超长背阔肌皮瓣修复四肢创面. 中国修复重建外科杂志, 2018, 32(12): 1572-1575. doi: 10.7507/1002-1892.201805042 复制

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