跨脐中线的胸脐皮瓣修复大面积软组织缺损

Design improvement and clinical application of free thoraco-umbilical flaps in the repair of massive soft-tissue defects

目的探讨游离胸脐皮瓣设计改进的可行性。方法2000-02～2006-08,采用常规胸脐皮瓣联合腹部随意皮瓣,切取跨脐中线的超大胸脐皮瓣,通过与受区血管吻合或以吻合血管的携带桥式将游离皮瓣移植于受区,达到修复创面。临床应用23例。结果术后23例,除1例皮瓣远端皮缘坏死,经换药处理成活,其余全部成活,皮瓣无肿胀,为二期功能重建创造了良好的软组织条件。结论胸脐皮瓣联合腹部随意皮瓣,切取跨脐中线的超大胸脐皮瓣,操作简便,最大限度地利用了腹部供区修复创面,修复较大软组织缺损是可行的。

Objeetive To study the possibility of the design improvement of free thoraco-umbilical flaps. Method From January of 1999 to June 2006, improved overlarge thoraco-umbilical flaps spanning median line were clinically applied in 23cases with wide area defect. Result Except for one case, in which overlarge thoraco-umbilical flaps appeared the skin edge necrosis and through dress-changing treatment, the wound healed; in other cases flaps lived, and no swelling, good soft tissue was created for two-phrase surgery. Conclusion Overlarge thoraco-umbilical flaps spanning median line improvement make pedicle easier to suture, flap to rotate in great radian, to resist vascular pedicle torsion, and tube design improvement may exploit donor area in the biggest degree to tissue defect.