保留胸背神经的背阔肌皮瓣游离移植

Clinical outcome of latissimus dorsi flap without excision thoracodorsal nerve transplants

目的 为减少背阔肌皮瓣切取时供区的代价 ,尽可能保留肌皮瓣切取后背阔肌的功能。 方法 通过了解胸背神经、血管的解剖特点 ,切取肌皮瓣时不将胸背神经完全切断 ,保留部分或全部神经的支配。手术前后对背阔肌的神经肌肉动作电位进行检查 ,了解术后保留的背阔肌功能。临床应用 2 0例修复下肢或前臂软组织缺损或伴骨外露。 结果 19例移植皮瓣成活良好 ,保留的背阔肌有收缩功能存在。 结论 在切取一定大小的背阔肌皮瓣时 ,保留胸背神经的支配 ,可减小背阔肌的功能损失 ,使供区的代价降低 ,符合皮瓣切取原则。

Objective To reduce the sacrifice of the donor site and remain the preserved latissimus dorsal muscle function. Method The anatomy characteristic of thoradorsal vessel and nerve,separate the nerve from artery and preserve the nerve in the donor site was studied. The function of preserved muscle were tested after operation. In clinicaly,we treated 20 cases with this method. Results The latissimus dorsi flaps were survived without any problem of blood supply after transplantation in 19 cases,and the function of the muscle contraction in the donor site can be tested after operation. Conclusion Harvesting latissimus dorsi flap without excision thoracodrsal nerve can reduce the function loss of latissimus dorsi muscle.