双叶背阔肌肌皮瓣修复大面积深部组织缺损

Bilobed latissimus dorsi flap for reconstruction of large deep tissue defects

目的介绍一种新的背阔肌设计切取方法,修复大面积深部组织缺损。方法 6例大面积深部组织缺损患者,其中头顶部创面缺损4例,下肢创面缺损2例,创面宽度均>8 cm。采用双叶背阔肌肌皮瓣设计,在患者一侧背部远近端切取两个依靠深部肌肉相连的较小的背阔肌肌皮瓣,两叶皮瓣在受区进行拼接修复较大的缺损,而供区直接拉拢缝合。结果术后6例患者的移植皮瓣全部成活,最大皮瓣切取面积为18 cm×16 cm。所有皮瓣供区直接拉拢缝合,仅遗留线性瘢痕。随访3～6个月后,移植皮瓣成活良好、柔软、色泽佳,供区的外形和功能满意。结论应用双叶背阔肌肌皮瓣设计可以最大限度减少供区的数目和损伤,并能获得最佳的供区术后外观。

Objective To introduce a new incision method for latissimus dorsi flap in reconstruction of large deep tissue defects.Methods Six patients with large deep tissue defects were selected,including 4 patients with wound defects in parietal region and 2 patients with wound defects in lower extremity,and the width of wound was more than 8 cm for each patient.The bilobed latissimus dorsi flap was designed,and two smaller skin paddles were lined up on one side of the back.The smaller skin paddles allowed primary closure of donor site,and were used to resurface a large defect when combined.Results The transplanted skin flaps survived in all the 6 patients,and the maximum area of skin flap was 18 cm×16 cm.The donor sites were closed primarily in all patients,with linear scar left only.Patients were followed up for 3 to 6 months,and all were satisfied with the aesthetic and functional outcomes of the donor sites.Conclusion The design of bilobed latissimus dorsi flap allows reconstruction of a large defect and primary closure of the donor site,with less invasion and favorable appearance.