扩张背阔肌节段肌皮瓣治疗前胸部广泛瘢痕挛缩

Expended Muscle-Sparing Latissimus Dorsi Myocutaneous Flap for the Repair of Extensive Scar Contracture Deformity in Chest

目的探讨扩张背阔肌节段肌皮瓣在前胸部广泛瘢痕挛缩畸形中的应用价值。方法2010年10月至2012年10月，对8例（11侧）前胸部广泛瘢痕挛缩患者应用扩张背阔肌节段肌皮瓣进行修复。治疗分两期，Ⅰ期：术前超声定位胸背动脉外侧支肌皮穿支的体表投影，设计含有胸背动脉外侧支肌皮穿支的背阔肌前缘节段肌束的胸背部皮瓣，分离腔隙后，放置扩张器，扩张器注水4~6个月；Ⅱ期：胸部瘢痕松解、切除，乳腺组织复位，以胸背动脉主干或外侧支为蒂，背阔肌扩张节段肌皮瓣转移修复。结果所有皮瓣全部成活，供区可直接缝合。随访3~20个月，皮瓣质地柔软，色泽与胸部接近。术后患侧肩关节内收、内旋、后伸力量无明显减弱，背部无明显凹陷畸形，女性患者乳房形态满意。结论应用背阔肌节段肌皮瓣预扩张术修复前胸部广泛瘢痕挛缩畸形，是一种较为理想的治疗手段，值得推广。

Objective To explore the clinical application of expanded muscle-sparing latissimus dorsi myocutaneous flap in repairing extensive scar contracture deformity of chest. Methods From October 2010 to October 2012, 8 cases with extensive scar contracture deformity in chest were treated by expended muscle-sparing latissimus dorsi flap, including 3 bilateral cases. The operation was divided into two stages. Stage one： A Doppler probe was used to mark the location of lateral myocutaneous perforators of thoracodorsal artery （LMTA）. The muscle-sparing latissimus dorsi flap was designed based on LMTA. Flap undermined in accordance with design, and then tissue expander was implanted. The expansion time was 4 to 6 months. Stage two： The scars were excited, the breast tissue was relocated at the normal anatomic position. The expended muscle-sparing latissimus dorsi flap was transplanted to cover the defects. Results All the flaps survived, and all donor sites were closed primarily. All the patients were followed up for 3 to 20 months, the texture and color of the flap was similar to chest skin. There was no difference in strength or range of motion around shoulder joint comparing with opposite shoulder joint. No depressed deformity was observed and the appearance of breast was excellent in female patients. Conclusion It is an ideal method to repair extensive scar contracture deformity in chest with expended muscle-sparing latissimus dorsi myocutaneous flap.