游离胸背动脉穿支皮瓣桥式移植修复小腿软组织缺损

Repair of Soft Tissue Defect of Leg Using Thoracodorsal Perforator Flap by Bridge Transfer

目的总结游离胸背动脉穿支皮瓣或肌瓣桥式移植修复小腿软组织缺损的临床应用效果。方法自2006年9月至2009年1月,应用游离胸背动脉穿支皮瓣或肌瓣桥式移植修复小腿软组织缺损11例,缺损范围4cm×8cm至8cm×22cm。皮瓣切取连带肩胛下与旋肩胛血管,血管蒂呈"T"形,与健侧小腿胫后动脉行端端吻合,血管蒂用中厚网状游离植皮覆盖。结果除1例术后皮瓣远端发生小的表浅感染,经换药后愈合外,本组皮瓣全部成活。术后随访9个月至3.6年(平均2.9年),没有发现明显的供区功能障碍,供区与受区外形较好,健侧小腿经临床观察与Doppler检查,胫后动脉通畅。结论本方法适用于修复四肢软组织缺损后,患者仅存1条主要动脉者;行桥式游离胸背动脉穿支皮瓣或肌瓣移植不损伤健侧小腿胫后动脉,降低了对供区的损伤。

Objective To summarize clinical results of free thoracodorsal perforator flaps or muscle flaps by the bridge transplantation in the repair of soft tissue defect of the leg.Methods From September 2006 to January 2009,11 patients with soft tissue defect of the leg underwent reconstruction with free thoracodorsal perforator flap or muscle flap by the bridge transplantation.Soft tissue defect ranged from 4 cm × 8 cm to 8 cm × 22 cm.The thoracodorsal artery perforator flaps or muscle flaps were elevated with subscapular and circumflex scapular vessels forming a ＂T＂ pedicle.The ＂T＂ shaped vascular pedicle of the thoracodorsal artery perforator flaps or muscle flaps were anastomosed to the two vascular ends of the posterior tibial artery of normal leg by end-to-end anastomosis.Immediate coverage of the vascular pedicle were performed by a meshed split-thickness skin graft.Results One flap developed minor superficial skin infection and distal part,the wound healed after change dressing.The thoracodorsal artery perforator flaps or muscle flaps survived completely without major complications and with satisfactory clinical results.Follow-up period ranged from 9 months to 3.6 years（mean 2.9 years）.There was no remarkable donor site morbidity.All cases had good appearance in recipient and donor site.The patency of the posterior tibial artery of contralateral legs were demonstrated by Doppler examination.Conclusion This technique is particularly useful in the reconstructive of the leg.The patency of the posterior tibial artery of contralateral leg are preserved in clinical application of the bridge free thoracodorsal artery perforator flaps or muscle flaps.This technique can reduce the injury at the donor site.