游离胸背动脉穿支皮瓣移植的临床应用

Clinical application experience of free thoracodorsal artery perforator flap transplantation

目的总结游离胸背动脉穿支皮瓣移植修复四肢皮肤软组织缺损的临床应用经验。方法临床应用游离胸背动脉穿支皮瓣修复23例四肢皮肤软组织缺损,其中单纯穿支皮瓣16例,分叶皮瓣1例,嵌合背阔肌肌瓣4例,联合旋肩胛动脉穿支皮瓣2例。皮瓣最大面积26 cm×10 cm,最小7 cm×4 cm。单纯皮瓣则完整保留背阔肌和胸背神经,供区直接缝合。4例皮下脂肪肥厚的皮瓣进行了显微均匀修薄。结果 22例穿支皮瓣完全成活,仅1例皮瓣远端部分坏死,坏死创面经二期植皮愈合。随访3～24个月,皮瓣血运良好,质地柔软,外形满意。供区直接闭合,但有5例供区创口有较宽而明显的瘢痕增生,上肢肩关节活动正常,供区损害很小。结论游离胸背动脉穿支皮瓣质地柔软、外观良好、供区损伤小,可以切取分叶皮瓣和嵌合肌瓣,显微修薄简单快捷,是修复四肢皮肤软组织缺损的理想皮瓣之一。

Objective To summarize the clinical application experience of free thoracodorsal artery perforator flap transplantation for repairing soft tissue defects in limbs.Methods Free thoracodorsal artery perforator flap transplantation was clinically applied to repair 23 cases of soft tissue defects in limbs.Of all flaps,16 cases were single perforator flaps,1 case was polyfoliate flap,4 cases were chimeric latissimus dorsi muscle flaps and 2 cases were combined with circumflex scapular artery perforator flaps.The sizes of dissected flaps ranged from maximal 26 cm×10 cm to minimal 7 cm×4 cm.Latissimus dorsi muscle and thoracodorsal nerve were reserved in single perforator flaps,and the donor sites were sutured directly.Superficial adipose of 4 cases fat flaps were debulked uniformly with operative microscope.Results 22 cases flaps survived completely and the wound healed primarily,but the distal segment in 1 case was partially necrosized and healed eventually after dressing change and skin graft.The following-up of the flaps ranged from 3 months to 24 months.All flaps were characterized by rich blood supply,soft texture and satisfactory appearance.The donor sites of all flaps were sutured directly,but there existed obviously wide scar hyperplasia in the donor sites of 5 cases flaps.The function of shoulder joints restored fully,the damage to donor sites was very small.Conclusion The free thoracodorsal artery perforator flap transplantation is one of ideal options for repairing soft tissue defect in limbs,because it has so many advantages such as soft texture,satisfactory appearance,less damage to donor site,cutting-out of polyfoliate flap and chimeric muscle flap,and easy microdissection of super-thin flap.