应用肌皮瓣治疗胸部放射性溃疡合并肋(软)骨炎

Repair radiation ulcer with thoracic costal chondritis by musculocutaneous flap

目的:探讨胸部放射性溃疡合并肋(软)骨炎的治疗方法.方法:彻底清除坏死、变性、感染的溃疡组织、肋(软)骨组织,扩大切除周边的瘢痕、纤维化组织后,应用下腹部横行腹直肌肌皮瓣和背阔肌肌皮瓣修复创面并部分再造乳房.结果:本组8例患者,创面应用下腹部横行腹直肌肌皮瓣4例,应用背阔肌肌皮瓣4例.其中7例伤口均2wk内愈合,1例术后因蒂部隧道周围死腔、积液引发局部感染,经部分拆线减小张力、湿敷换药、补充植皮后闭合创面.结论:应用肌皮瓣修复是治疗胸部皮肤放射性溃疡合并肋软骨炎的好方法.

AIM：To explore the treatment of radiation ulcer with thoracic costal chondritis. METHODS：We followed the procedures of clearing the necrotic,degenerative and infected tissue thoroughly,repairing the wound and reconstructing the affected breast by TRAM flap and latissimus dorsi myocutaneous flap after enlarged resection of the scar and the fibrotic tissue. RESULTS：Four cases were treated by TRAM flap and another 4 cases by latissimus dorsi myocutaneous flap. Of the 8 cases,7 patients achieved primary healing in 2 weeks. Healing was delayed in the other one case because of local infection from dead space and hydrops in the pedicel tunnel,which was solved by skin graft after the treatment of hydropathic compression and dressing changing. CONCLUSION：It is a good surgical method to repair radiation ulcer with thoracic costal chondritis by musculocutaneous flap.