腹直肌肌皮瓣转位修复躯干周缘肿瘤性缺损

Repair of the margin trunk defects by transplant of rectus abdominis myocutaneous flap

目的介绍带蒂腹直肌皮瓣转位修复躯干周缘肿瘤性缺损的治疗方法。方法1998年3月至2005年3月,应用本法共修复肿瘤性躯干缺损14例,其中恶性纤维组织细胞瘤5例,乳腺癌4例,鳞状细胞癌2例,滑膜肉瘤1例,脂肪肉瘤1例,纤维瘤病1例。原发4例,复发10例。肿瘤切除后,胸壁缺损(包括腋窝)6例,侧腰部缺损4例,腹股沟区缺损4例。同侧转位4例,对侧转位10例。以腹壁上动脉为营养血管的向上转位6例,以腹壁下动脉为营养血管向下转位8例。2例同时行人造血管移植,1例后装治疗。结果围手术期,11例,全部成活;3例部分坏死,1例需再次修复。1例失访,13例平均随访15个月,局部复发2例,肺转移死亡2例,余均恢复正常生活。结论腹直肌肌皮瓣带蒂转位可以全方位修复躯干周缘360°缺损。

Objective To introduce outcome of the defects after resection tumors in the margin trunk treated by transposition of rectus abdominis myoeutaneous flap（RAMF）. Methods From March 1998 to March 2005, 14 cases（ male and female each 7） with the defects of margin trunk were treated by transposition of RAMF. Among them, malignant fibrous histocytoma were 5, breast cancer 4, squamous cell cancer of skin 2, synovial sarcoma 1, liposareoma 1, fibromtosis 1, and 4 cases were primary and 10 recurrence. The defect of chest wall were 6 （ including axilla） , the lateral abdomen wall 4 and the groin 4 after the tunors resection. six cases of upward transposition were the pedicle with the superior epigastric artery., and 8 of downward transplant were the pedicle with the inferior epigastric artery, and contralateral transplanted 10 and contralateral transplanted 10 and ipsilateral 4. The vessel grafts replacement operated in two, and the after loading performed in one. Results Eleven of RAMF survived total and partial necroses were three and re-repair was one only. 13 patients were followed up averagel 15 months： the local recurrence were 2, the die were 2 and 10 patients retured to normal. Conclusion The transplant of RAMF can repair all defects of margin trunk in the 360°.