肌皮瓣在修复前胸壁慢性放射性溃疡中的应用

The application of the myocutaneous flap to repalred the chronic radiation ulcer on anterior chest wall

乳腺癌根治术后辅助放射治疗是预防癌肿复发的重要治疗措施之一。但由于根治手术破坏了前胸壁正常结构和放射线具有的致伤特性，被射线照射的区域易发生放射性损伤甚至溃疡。此类溃疡虽经换药和游离植皮却常常经久难愈。我们对２１例乳癌根治术后放疗引起的前胸壁慢性放射性溃疡病人，采用病灶切除后分别应用背阔肌皮瓣、胸大肌皮瓣和腹直肌皮瓣转移修复创面，治疗效果良好，１９例创面Ⅰ期愈合，２例创面Ⅱ期愈合。应用带血运的肌皮瓣转移修复创面解决了前胸壁区因根治手术或放射线所致的血管损伤而引起的创面难愈问题。对于肌皮瓣的选择，如胸背血管情况良好者首选背阔肌皮瓣，如该血管被原手术或放射线损伤。

Radiatherapy after radical mastectomy owing to mastocarcinoma is one of important precautionary measure to prevent the relaps of tumors. The normal structure of anterior chest wall was destroied by radical operation and the radiation be of the feature to damage tissue, so that the radiation region easy presented radiation damage even ulcer. The ulcer is often difficult to deal with for a long time, although the changing dressing and free skin grafting were used. 21 cases with radiation ulcer on anterior chest wall were treatmented, by use of latissmus dorsi myocutaneous flap, pectoralis major myocutaneous flap and redus abdominal myocutaneous flap to repaired tissue defect following resection of radiation ulcer. 19 cases healed by the first intention, 2 cases healed by the second intention. The use of the myocatenous flap with blood supply to repaired wounds by transposition solved the problem that was unheal with wound because of the vesseles in anterior chest wall was damaged by radical operation or radiation. If the thoracodorsal vessel is perfect, the latissmus dorsi myocutaneous flap first was choiced to used. If it was damaged by operation or radiation, the pectoralis majior myocutaneous flap or rectus abdominal myocutaneous flap should were used. 