肋间动脉增压超长背阔肌皮瓣修复四肢创面

Application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair

目的探讨肋间动脉增压超长背阔肌皮瓣修复四肢创面的疗效。方法 2016年1月—2017年12月,采用肋间动脉增压超长背阔肌皮瓣修复四肢软组织缺损5例。男4例,女1例,年龄43～59岁,平均45.8岁。受伤至皮瓣修复时间为7～25 d,平均12.3 d。致伤原因:机器绞伤2例,交通事故伤2例,机器挤压伤1例。创面位于上肢前侧3例、后侧1例,小腿后侧1例。创面范围为26 cm×8 cm～38 cm×10 cm。背阔肌皮瓣切取范围为36 cm×6 cm～43 cm×7 cm,肌瓣切取范围为36 cm×10 cm～43 cm×15 cm。供区均直接拉拢缝合。结果术后1例背阔肌皮瓣远端坏死,经对症处理后愈合;其余4例皮瓣完全成活,创面均Ⅰ期愈合。供区切口均Ⅰ期愈合。5例患者均获随访,随访时间8～18个月,平均14.9个月。皮瓣外形满意、质地柔软,有排汗功能。结论肋间动脉增压超长背阔肌皮瓣修复四肢创面能减少皮瓣远端坏死并发症的发生,取得满意临床疗效。

Objective To explore the clinical application of vascular augmentation of an extra-long latissimusdorsi flap through an intercostal artery in limb wound repair. Methods Between January 2016 and December 2017,5 patients with limb wounds were treated with the extra-long latissimus dorsi flaps. The vascular augmentation of theextra-long latissimus dorsi flap through the intercostal artery was applied during the operation. There were 4 males and1 female, with an average age of 45.8 years (range, 43-59 years). The time from post-traumatic admission to flap repair was7-25 days (mean, 12.3 days). The causes of injury included machine injury in 2 cases, traffic accident in 2 cases, and rollercrush injury in 1 case. The wounds were located at the anterior of upper limb in 3 cases, the posterior of upper limb in1 case, and the posterior of leg in 1 case. The size of wounds ranged from 26 cm×8 cm to 38 cm×10 cm. The size of thelatissimus dorsi flap ranged from 36 cm×6 cm to 43 cm×7 cm. The size of the muscle flap ranged from 36 cm×10 cm to43 cm×15 cm. The donor sites were closed directly. Results The distal flap necrosis occurred in 1 case and healed aftersymptomatically treatment. The other flaps survived completely. The wounds and incisions at donor sites healed by firstintention. All patients were followed up 8-18 months with an average of 14.9 months. At last follow-up, the flaps hadsatisfactory appearances, soft textures, and function of sweating. Conclusion Application of vascular augmentation ofthe extra-long latissimus dorsi flap through the intercostal artery in repair of limb wound can reduce the incidence ofdistal flap necrosis and achieve satisfactory effectiveness.