应用健侧胸壁网球拍状皮下筋膜蒂皮瓣修复乳腺癌术后放射性溃疡

Application of ＂tennis racket＂ flap with fascial pedicle on the healthy chest for the radiation ulcer after surgical treatment of breast carcinoma

目的 介绍一种简单、实用而又打破传统任意皮瓣长宽比例限制的的网球拍状皮下筋膜蒂皮瓣在乳腺癌术后放射性溃疡修复中的应用.方法 在以胸廓内动脉穿支为主导的肋间穿支系统供血范同内,于健侧胸壁沿肋骨走向设计皮瓣,皮瓣不带知名血管,蒂部近胸骨,以皮下组织蒂（含筋膜）为蒂似网球拍状,通过隧道转移修复对侧乳腺癌术后放疗所致溃疡.临床治疗9例,皮瓣最大11 cm×13 cm,最小5.0 cm ×3.5 cm,蒂宽2.0～3.0 cm,蒂长2～～8 cm.结果 9例网球拍状皮下筋膜蒂皮瓣全部成活,外形理想,随访3个月到3年,溃疡无复发.结论 网球拍状皮下筋膜蒂狭长窄蒂皮瓣不带知名血管,无需解剖血管,切取容易;其长宽比例超过常规任意皮瓣,蒂部狭长使其旋转和覆盖范围大,供区范围大,可切取包括乳房下皱襞皮肤的健侧胸部软组织,是修复部分乳腺癌术后放射性溃疡较为理想的皮瓣.

Objective To introduce the application of ＂tennis racket＂ flap with fascial pedicle on the healthy chest for radiation ulcer after surgical treatment of breast cancer.Methods The ＂ tennis racket＂ flap was designed on the healthy chest along the cartilage with fascia pedicle near the sternum.9 cases were treated.The flaps size ranged from 5.0 cm × 3.5 cm to 13 cm× I l cm with pedicle size of 2-8 cm in length and 2.0-3.0 cm in width.Results All the 9 flaps survived completely with satisfactory appearance.The patients were followed up for 2 months to 3 years without ulcer reoccurrence.Conclusions The ＂tennis racket＂ flap has a slender fascial pedicle without major blood vessel.It has the advantages of good flexibility for rotation and large flap size for the reconstruction of the radiation ulcer after surgical treatment of breast cancer.