分叶肩胛皮瓣的临床应用

Clinical application of the free ramified scapular flap

目的 介绍分叶肩胛皮瓣的设计及其在软组织缺损修复中的应用。方法2002年3月至2006年6月，对9例手部软组织缺损患者，根据缺损创面的大小和相邻创面的距离，结合旋肩胛动脉的分支特点设计一蒂双叶或三叶肩胛皮瓣,进行游离移植修复创面。男6例,女3例；年龄26-48岁，平均3l岁。皮瓣分叶形式有：降支皮瓣＋升支皮瓣4例，降支皮瓣＋横支皮瓣3例，降支皮瓣＋横支皮瓣＋升支皮瓣2例。皮瓣切除的范围：升支皮瓣3．5cm×3cm～6cm×4cm大小,横支皮瓣4cm×3cm～12cm×6cm大小,降支皮瓣7cm×6cm～13cm×6cm大小。血管蒂吻合方式：旋肩胛动、静脉与桡动脉、头静脉端端缝合7例,与尺动脉、贵要静脉端端缝合2例。供区处理：创缘皮肤直接拉拢缝合6例,中心部分缺损切取创面两端皱角皮肤植皮3例。结果9例皮瓣全部成活，肩胛供区一期愈合。l例术后第l天出理动脉危象，探查解除血管蒂在隧道内卡压后血运恢复。术后随访6-4个月,平均16．5个月，其中2例患者二期行分指、皮瓣修薄术。所有皮瓣色泽、质地良好。结论以旋肩胛动脉的三个皮肤分支为解剖基础的分叶肩胛皮瓣的临床设计属一蒂多轴分叶皮瓣类型,各瓣血供充分，能较好地修复手部相邻多处软组织缺损。

Objective To introduce the design and clinical application of free ramified scapular flap in treatment of the soft tissue defects. Methods From March 2002 to June 2006, 9 cases with soft tissue defects in hand, which included 6 males and 3 females with the an average age of 31 years, were repaired with free ramified scapular flap. According to the area of defects and the distance between of wounds, based on the skin branch paths of circumflex scapular artery anatomy, a pedicle of two or three ramification scapu- lar flaps were designed and transplanted. The forms of ramification flap are： lower branch flap and upper branch/lap in 4 cases, lower branch flap and transverse branch flap in 3 cases, lower branch flap and transverse branch flap and upper branch flap in 2 cases. Range of the flaps are： 3.5 cm×3 cm-6 crux4 cm of upper branch flap, 4 cm×3 cm- 12 cm×6 cm of transverse branch flap, 7 crux6 era- 13 cm×6 cm of lower branch flap. The style of vascular anastomosis： end to end anastomosis were used in 7 cases between the circumflex scapular artery and vein with radial artery and cephalic vein, and in another 2 cases between the circumflex scapular artery and vein with ulnar artery and basilica vein. The ways of closed the scapular area wound： it can be closed directly by suturing skin with a suitable tension in 6 cases. And in another 3 cases, they were covered with skin grafting in the center of the wound. Results All flaps survived. One patient who experienced circulatory crisis the first day after operation, due to entrapment of pedicle in the tunnel needed an emergency operation to dispense from the symptoms. The average follow-up time was 16.5 months （ranged from 6 to 24 months）. The plastic operation incluing flap defatting and fingers splitting were performed in 2 cases, and the appearance including color, texture was good and excellent in all cases. Conclusion The design of free ramified scapular flap is based on the skin branch paths of circumflex scapular artery anatomy, every flap can get the rich blood supply from the circumflex scapular artery. It is good used in repair soft tissue defects of hand.