应用背阔肌岛状肌皮瓣修复烧伤后乳房畸形

Latissimus dorsi myocutaneous flap for burned breast reconstruction

目的介绍应用背阔肌岛状肌皮瓣修复前胸壁烧伤后所致乳房瘢痕挛缩畸形的临床效果。方法应用扩张或未扩张的背阔肌岛状肌皮瓣修复烧伤后乳房瘢痕、部分缺损畸形，其中轻、中度烧伤后乳房缺失2例，采用背阔肌岛状肌皮瓣修复重度乳房缺失5例，采用扩张的背阔肌岛状肌皮瓣修复。结果共治疗7例，术后肌皮瓣完全成活，乳房形态明显改善，无肌皮瓣坏死、背部伤口感染、裂开及肩部功能障碍等并发症发生。供区无明显后遗畸形及功能障碍。结论背阔肌岛状肌皮瓣血运良好，操作简便易行，是修复烧伤乳房畸形的较好方法。

Objective Thermal burns of the anterior chest disfigure the female breast, and the postburn breast deformity is a sequela of severe scar contraction of the burned chest. For deformities that affected the mammary development, museulocutaneous flaps were used. Here we introduce our experience in using the latissimus dorsi myocutaneous island flap in burned breast reconstruction. Methods During the past 7 years, 7 female patients with such deformities required reconstruction, the expanded or unexpanded latissimus dorsi musculocutaneous island flaps were used in the partial reconstruction of burned breast. In the mild deformities group （2 cases）, unexpanded latissimus dorsi musculocutaneous island flaps were used. For patients with undeveloped mammary glands （5 cases）, expanded latissimus dorsi musculoeutaneous island flaps were used. Results The procedure was performed in 7 patients and all the flaps were alive, with significant improvement of breast appearance. The complication rate was low. There were no deformity and dysfuction in the donor site. Conclusions The technique has many advantages： beautiful contour of breast, good blood supply of the flap, no donor site morbidity. It provides the plastic surgeon with an excellent, safe and consistently successful method for burned breast reconstruction. This experience has led to development of surgical principles and techniques tailored to this particularly difficult problem.