应用背阔肌肌皮瓣游离移植修复下肢皮肤软组织缺损

Treatment of skin and soft tissue defects in the lower leg with free latissimus dorsi flap transplantation

目的探讨应用背阔肌肌皮瓣游离移植修复下肢大面积皮肤软组织缺损的手术方法和临床效果。方法对16例下肢广泛的皮肤软组织缺损患者先行清创,然后行吻合血管的背阔肌肌皮瓣游离移植修复创面。结果16例背阔肌肌皮瓣全部成活。其中2例术后出现血管危象,经手术探查吻合血管后成活。14例患者创面Ⅰ期愈合,2例皮瓣出现浅表坏死,经换药及抗感染治疗后愈合。其中,随访12例患者1个月至2年,皮瓣外形及功能满意。结论背阔肌肌皮瓣具有解剖位置恒定、血管蒂长、口径粗、血运丰富、抗感染能力强等特点,对无法采用局部带蒂肌皮瓣修复下肢皮肤软组织缺损的患者,应用背阔肌肌皮瓣游离移植是一种疗效可靠的治疗方法。

Objective To evaluate the curative effect of repairing the massive tissue defects in the lower leg with free latissimus dorsi museulocutaneous flap. Methods A total of 16 patients with massive tissue defeetss were performed in this study. During the treatment, we debrided the defects, and then transplanted the latissimus dorsi musculoeutaneous flaps to the recipient sites by vascular anastomosis. Results All the flaps are survived. Circulation crisis occurred in 2 cases postoperatively, and the flaps were saved by vascular anastomosis. 14 patients were healed in the first stage. 2 patients suffered with the superficial necrosis which were cured after dressing change combined with anti- infective therapy. Followed up from 1 month to 2 years, 12 patients were all satisfied with the cosmetic and functional results. Conclusion With the characteristics of constant anatomic position, long vascular pedicle, large caliber, abundant blood supply, and strong anti - infectious ability, the latissimus dorsi musculocutaneous flap is widely used in reconstructive surgery. Free latissimus dorsi musculoeutaneous flap transplantation is a reliable and good choice to repair the massive tissue defects in the lower legs when the local pedicled musculocutaneous flap can not be found.