背阔肌皮瓣游离移植修复复杂创面:重建组织完整及功能需要

Latissimus dorsi free flap transfer for repair of complex wounds: the complete tissue and functional reconstruction

背景:随着显微外科技术的发展与推广,游离皮瓣移植在临床应用越来越广泛,皮瓣游离移植能够解决局部组织量不足的问题。目的:观察背阔肌肌皮瓣(肌瓣)游离移植对临床中出现的各类体表缺损的修复,以及重建组织完整及功能需要的作用。方法:选取2010至2013年各类体表缺损病例18例,运用显微外科技术,采取背阔肌肌皮瓣(肌瓣)游离移植修复复杂创面。根据缺损原因,对原发创面进行处理,分离受区动静脉血管。皮瓣大多选择来自缺损同侧的背阔肌肌皮瓣(肌瓣),根据缺损创面大小设计所需切取范围。如切取肌皮瓣(肌瓣)范围较大,继发创面难以直接缝合,可行游离皮片移植覆盖残余继发创面。结果与结论:移植肌皮瓣(肌瓣)均成活,术后血运正常,功能恢复良好,外观经过整形技术能让患者自觉较为满意。背阔肌肌皮瓣(肌瓣)由于它供瓣区面积大,且部位较为隐蔽,显微外科技术,提高了游离移植的背阔肌肌皮瓣(肌瓣)的成活率,对于复杂创面的修复具有很大的优势。

BACKGROUND： With the development of microsurgical techniques, free flap transplantation has been widely used, which can solve the problem of insufficient local tissues. OBJECTIVE： To observe the clinical effects of latissimus dorsi free flap transfer on the repair of all kinds of body surface defects, as well as the role in complete tissue and functional reconstruction. METHODS： From 2010 to 2013, 18 cases of various types of body surface defects were selected and using the microsurgical techniques, these complex wounds were repaired with free latissimus dorsi myocutaneous flaps. According to defect reason, primary wounds were treated for arteriovenous separation in the recipient zone. Most of the flaps were latissimus dorsi myocutaneous flaps at the affected side which were cut according to the wound size. If the cut muscle flap had a larger size and secondary wounds were difficult to be directly sutured, free skin grafts could be used to cover the residual secondary wounds. RESULTS AND CONCLUSION： After transplantation, all the flaps survived with normal blood supply and well-recovered function. Patients were more satisfied with the flap appearance. Latissimus dorsi myocutaneous flaps characterized as large donor area and secluded location have a great advantage in the repair of complex wounds using microsurgical techniques that can improve the survival rate of latissimus dorsi myocutaneous flaps.