以肩胛下血管为蒂的侧胸皮瓣修复上肢组织缺损

Lateral thoracic flaps pedicled with subscapular vessels for defects in the upper extremities

目的 探讨以肩胛下血管为蒂的侧胸皮瓣带蒂转移修复上肢较大面积组织缺损的可行性及临床效果. 方法 2003年6月至2009年9月,我们对5例上肢较大面积组织缺损的患者,应用以肩胛下血管为蒂的侧胸皮瓣带蒂转移修复,皮瓣切取面积为23 cm×8 cm～40 cm ×20 cm.术中将肩胛下血管、胸背血管和胸背血管外侧支及其皮穿支等营养血管均包含于皮瓣内.为了减少肌皮穿支的损伤,应在其周围携带2～3 cm宽的背阔肌袖.供瓣区创面直接缝合或移植皮片修复. 结果 单纯侧胸皮瓣带蒂转移4例、侧胸-脐旁联合皮瓣带蒂转移1例.转移的皮瓣除1例远端小部分坏死外,其余全部成活.4例患者获得2～14个月的随访,皮瓣色泽、质地及厚薄较满意,供、受区外形与功能恢复也较满意. 结论 带蒂转移的以肩胛下血管为蒂的侧胸皮瓣血供可靠,转移方便,供瓣区损伤小,是修复上肢较大面积组织缺损的理想方法.

Objective To investigate the feasibility and therapeutic effect of lateral thoracic flaps pedicled with subscapular vessels for defects in the upper extremities. Methods From June 2003 to September 2009,5 cases with large soft tissue defects in the upper extremities were treated with lateral thoracic flaps pedicled with subscapular vessels.The flap size ranged from 23 cm× 8 cm to 40 cm × 20 cm.The subscapular vessels,the thoracodorsal vessels,the lateral branch and the cutaneous perforators of thoracodorsal vessels were all included in the flap.A muscular sleeve of 2-3 cm in width was preserved to protect the musculocutaneous perforator.The defects in the donor area were closed directly or covered by skin graft. Results The lateral thoracic flaps were used in four cases.A combination of lateral thoracic flap and paraumbilical flap was used in one case.Partial necrosis happened at the distal portion of the flap in one case.All the other flaps survived completely.4 cases were followed up for two to fourteen months with satisfactory cosmetic and functional results.The color,texture and thickness of the flaps were also satisfactory. Conclusions The lateral thoracic flap pedicled with the subscapular vessel is flexible for repairing defects in the upper extremities with a reliable blood supply,leaving less morbidity to donor site.