巨大剔骨肌皮瓣的临床应用

Clinical application of large muscular flaps taken from major extremities following amputation

目的总结巨大剔骨皮瓣修复危及生命的难治性创面的临床价值和经验。方法在保留肢体软组织的情况下,手术高位截断肱骨、股骨或行髋关节、肩关节离断术,形成血供丰富的巨大剔骨肌皮瓣,用于修复肿瘤术后放射治疗、躯干恶性肿瘤切除后以及高压电烧伤形成的危及生命的巨大难治性创面。结果7例巨大剔骨肌皮瓣血运良好全部成活,术后创面得到有效覆盖,疼痛明显减轻,全身情况好转,生存质量提高。7例中4例治愈,3例最终因原发肿瘤转移或并发症死亡。结论应用肢体巨大剔骨肌皮瓣能有效覆盖和修复巨大危及生命的难治性创面,提高患者生存质量,对经过慎重选择手术指征的病例不失为牺牲局部保存整体的有效选择。

Objective To explore the clinical significance of using large muscular flaps taken from major extremities preparing to be amputated to treat life-threatening refractory wounds. Methods Keeping the soft tissue of the extremities, following amputation of proximal humerus, proximal femur, shoulder or hip to obtain large muscular flaps with good blood supply to repair life-threatening refractory wounds of seven patients caused by radiotherapy, resection of malignant tumor or electrical burn. Results All flaps survived completely with good blood circulation. The dimension of the flaps was large enough to reconstruct these wounds. Patients reported good pain relief, health and life improvement. Four patients fully recovered while the other three died of the metastasis of the cancer or complications. Conclusions Sometimes, amputation, obtaining and application of the muscular flap is an effective method to repair the large refractory wounds.