向上臂延伸的肩胛游离皮瓣的临床应用研究

Clinical application of the scapular free flap extended to the upper arm

目的应用向上臂延伸的肩胛游离皮瓣一期修复面颈部和上唇瘢痕切除后创面。方法在设计肩胛游离皮瓣时，应用常规的肩胛旁皮瓣修复面颈部瘢痕切除后所遗创面，同时，将肩胛皮瓣向上臂后内侧延伸，延伸部分用以修复上唇缺损。结果本组6例，均为烧伤后上唇、面颈部瘢痕患者，皆应用向上臂延伸的肩胛皮瓣修复上唇、面颈部瘢痕切除后所遗创面，背部肩胛旁皮瓣面积为22cm×11cm～40．0cm×9．5cm，平均36．57cm×10、20cm，向上臂延伸的皮瓣面积为7cm×4cm～12cm×4cm，平均10．32cm×3．67cm，皮瓣全部成活。结论向上臂延伸的肩胛游离皮瓣，其延伸部分的血供除来自旋肩胛动脉的分支血管外，旋肩胛动脉和旋肱后动脉之间还存在直接交通支血管，旋肱后动脉切断后，旋肩胛动脉通过上述直接交通支血管可以供应旋肱后动脉在上臂的皮肤分布区；将肩胛游离皮瓣向上臂延伸，可在修复面颈部瘢痕挛缩的同时，修复上唇缺损，皮瓣血运可靠，手术效果良好。

Objective To apply the scapular free flap extended to the upper arm for resurfacing the face and neck, as well as the upper lip in one stage, Methods The scapular free flap was designed with extended portion to the posterior and interior part of the upper arm. Then the free flap was transferred to resurface the face and neck with the routine portion and to resurface the upper lip with the extended portion. Results 6 cases with extensive upper lip, facial and cervical burn scar were treated with the extended scapular free flaps. The flap size ranged from 22 cm× 11 cm to 40 cm× 9.5 cm（ 36.57 cm× 10.20 cm in average）for the routine portion and from 7 cm× 4 cm to 12 cm× 4 cm（ 10.32 cm× 3.67 cm in average） for the extended poriion, All flaps survived completely. Conclusions There are direct communicating branches （＂choke vessel＂） between the circumflex scapular artery （CSA） and the posterior humeral circumflex artery （PHCA）. When the blood supply of PHCA is cut off, the CSA can provide blood supply through the communicating branches to the upper arm skin area previously nourished by PHCA. So the blood supply of the extended portion of the scapular free flap is not only from the branches of CSA, but also from the direct communicating branches between the CSA and PHCA. The extended scapular free flap has a reliable blood supply and can be applied to construct the facial and cervical scar contraction with the extended portion to resurface the upper lip. The satisfactory result can be expected.