背阔肌穿支皮瓣的临床应用

Clinical application of latissimus dorsi perforator flap

目的探讨背阔肌穿支皮瓣在组织缺损修复中的应用价值。方法应用背阔肌穿支皮瓣进行整复手术21例,其中面、颈部修复8例;胸前创面和腋窝软组织缺损3例;四肢创面修复10例。皮瓣游离过程中保留胸背神经和背阔肌不受影响,形成单纯的穿支皮瓣。本组病例皮瓣大小为6 cm×8 cm^15 cm×21 cm,其中带蒂移植3例,游离移植18例。结果皮瓣全部成活,受区修复外形满意。供区背阔肌功能保留完整,直接缝合或游离植皮后外观均优于传统背阔肌皮瓣。结论背阔肌穿支皮瓣最大限度减少了供区的损伤;皮瓣较薄,克服了传统背阔肌肌皮瓣过分臃肿的缺点,扩大了应用范围。

Objective To study the clinical application of latissimus dorsi perforator flap in tissue defect repair. Methods Thoracodorsal perforator flaps were used in 21 cases with reconstructive surgery, including 8 facial and cervical repair, 3 protothorax wound repair and axillary soft tissue defect repair, and 10 limb wound repair. The flap size ranged from 6 cm × 8 cm to 15 cm × 21 cm, and 3 were pedicled flap grafting and 18 free grafting. Thoracodorsal nerve and latissimus dorsi muscle were free from hurt during the free flap procedure, and simple perforator flap was formed. Results All the perforator flaps survived with satisfactory results. The function of latissimus dorsi was well preserved postoperatively, and both direct suture and free grafting yielded better appearance than the traditional latissimus dorsi flap. Conclusion Compared with the traditional latissimus dorsi flap, the latissimus dorsi perforator flap is characterized by the thinness of tissue and minimal sacrifice of donor structure with the preservation of thoracodorsal nerve and latissimus dorsi muscle, which has an expanded application range.