全腹外斜肌筋膜皮瓣下移修复肿瘤性腹股沟和下腹壁缺损

Repair of the Groin and Low Abdominal Wall after Tumor Resection by Total Myofasciocutaneous Flap of Oblique External Abdominis Muscle Transposition

目的：介绍一种简单、安全有效的覆盖肿瘤切除后，腹股沟和下腹壁区缺损修复的新方法。方法：2005年9月～2007年12月，治疗4例患者。其中恶性纤维组织细胞瘤1例，纤维肉瘤1例，血管肉瘤1例，阴茎癌腹股沟淋巴结转移1例，全部病例均为多次手术后复发。切口起于腹股沟和下腹壁缺损区的内上角，沿中线走行至剑突后转向外上方，经由乳晕下方至腋后线。切开腹直肌前鞘的内缘，向外侧掀起腹直肌前鞘和续接的全腹外斜肌及其表面皮肤，形成具有宽大蒂部的肌筋膜皮瓣。然后，将皮瓣下移，覆盖在腹股沟和下腹壁缺损区。裸露的供区，利用皮肤和皮下组织的弹性，直接缝合。切除的范围从18×15～22×18cm，平均310cm^2。转位的肌筋膜皮瓣从30×17～37×20cm，肌筋膜皮瓣平均下移11cm以上。所有的创面均一期闭合，仅1例3×3cm区游离植皮。结果：4例转位的肌筋膜皮瓣全部成活，其中3例所有切口均一期愈合，1例下缘裂开，经换药愈合。平均随访11个月，复发1例。无腹壁疝出现。结论：应用全腹外斜肌筋膜皮瓣修复腹股沟区和下腹壁缺损，是一种简单，安全和有效的新方法。

Objective： To introduce a simple, safe and effective method for coverage of the soft tissue defect of the groin and low abdominal wall. Methods： Four cases （3 males and 1 female）, including 1 case of malignant fibrous histiocytoma, 1 case of fibrous sarcoma, 1 case of angiosarcoma and 1 case of inguinal lymph nodes metastasis of carcinoma of penis underwent multiple surgeries between September 2005 to December 2007. The average age was 69 （range 61-76）. The surgical incision started from the medial upper cornu of the defect of the groin and low abdominal wall to xiphisterum along the median line of the body, then turned to the posterior line of axillary fossae passing below mammary areola. The medial margin of front sheath of rectus abdominis muscle was cut, the complex of front sheath of rectus abdominis muscle and connected oblique external abdominis muscle with skin was lifted and a myofasciocutaneous flap of wide pedicel was formed. Then, the flap was moved to cover the defect of the groin and low abdominal wall. Exposed donor site was sutured directly. The average area of defect was 310cm^2 （ranged from 18× 15 to 18×22cm）. The range of myofasciocutaneous flap transposition was from 30×17 to 37×20cm. All wounds were closed primarily, except 1 case which had a grafting area of 3×3cm area grafting. Result： All of the myofasciocutaneous flaps were successful, achieving primary healing in 3 cases and second-stage healing occurred in 1 case. All patients were followed up for an average period of 11 months. One case had recurrence and no ventral hernia was observed. Conclusion： Repairing the defect of the groin and low abdominal wall after tumor resection with myofasciocutaneous flap of oblique external abdominis muscle is a simple, safe and effective method.