应用肋间后动脉穿支皮瓣修复微囊型淋巴管畸形切除后的大面积缺损

Closure of Large Defects after Microcystic Lymphatic Malformations Using Lateral Intercostal Artery Perforator Flap

目的 探讨微囊型淋巴管畸形（LMs）手术切除的可行性,并对肋间后动脉穿支（LICAP）皮瓣修复微囊型LMs切除后的大面积缺损的有效性进行评价。方法 2009年1月至2012年12月,对8例13-22岁腋胸侧壁微囊型LMs患者,应用MRI和B超确定病变切除的范围和层次,对彻底切除后均遗留的腋窝、胸侧壁皮肤组织缺损,应用LICAP皮瓣进行修复,7位患者皮瓣供区直接缝合,1位患者供区植皮覆盖。结果 应用LICAP皮瓣可成功修复所有微囊型LMs切除术造成的组织缺损。术后随访1-3年,皮瓣形态良好,B超和MRI证实无复发微囊腔出现,皮瓣供区无功能受损。结论 超声和MRI可为手术彻底切除病灶作精确定位并进行手术后评估。微囊型LMs手术切除术后遗留组织缺损可应用LICAP皮瓣获得良好的组织覆盖和修复,术后受区外形良好,供区无功能损伤。

Objective To evaluate the feasibility of complete removal of the multifocal and extensive lesions by accurate imaging diagnosis and to repair large skin defects due to complete resection of microcystic LMs using lateral intercostal artery perforator （LICAP） flap. Methods From January 2009 to June 2012, tissue defects in the axillary chest wall region of 8 patients aged from 13 to 22 years after microcystic LMs resections were closed using LICAP flap. Flap donor sites in all patients were closed primarily except one patient who underwent skin grafting. Before surgery, ultrasound and MRI examination were used to confirm the diagnosis and determine the scope and level of the abnormality for complete resection. Results All defects after microcystic LMs excision were successfully closed using LICAP flaps. The follow-up period ranged from 1 to 3 years （mean 2.1 years）. All flaps survived postoperatively. No recurrence occurred. Ultrasound and MRI also demonstrated flap survival without recurrence of microcystic LMs. No functional loss attributable to the LICAP flap harvest was identified. Conclusion Ultrasound and MRI are safe and accurate diagnostic imaging methods for the pre- and post-operative evaluation of the microcystic LMs in patients undergoing surgery. LICAP flap provides good coverage for the large defects and achieves acceptable morphology without functional deficits in donor sites.