南京“5．7”事故受照者急性放射性皮肤损伤的修复

The repair of acute radiation skin injury from ^192Ir source at ＂5. 7＂ radiation accident in Nanjing

目的 探讨游离背阔肌肌皮瓣在Ⅳ度急性放射性皮肤损伤修复中的应用。方法 对南京＂5.7＂放射事故受照者＂王＂的右大腿Ⅳ度急性放射性皮肤损伤进行救治。受照后62 d切除坏死组织;受照后171 d扩创,取联合皮瓣（右侧背阔肌肌皮瓣加肩胛骨皮瓣）游离移植修复创面; 受照后180 d,皮瓣部分坏死;受照后263 d再次扩创,取左侧背阔肌皮瓣游离移植修复残余创面。结果 右大腿Ⅳ度急性放射性皮肤损伤创面完全愈合,外形理想,并恢复大部分功能。结论 游离背阔肌肌皮瓣或其衍生的联合肌皮瓣,可以修复较大面积的Ⅳ度急性放射性皮肤损伤,并可达到功能和外形同时修复的效果,值得临床推广。

Objective To explore the application of free latissimus dorsi myocutaneous flap to repair of degree Ⅳ acute radiation skin injury.Methods Review and summary were made of the repair process of degree Ⅳ acute radiation skin injury on right thigh of a patient named ＂Wang＂. Necrotic tissues was excised 62 d after radiation exposure. The extended wounds were covered 171 d after exposure with free joint latissimus dorsi myocutaneous flap （on the right latissimus dorsi myocutaneous flap and shoulder flap joint）. The flap necrosis due to vascular anastomosis thrombosis was noted in part 180 days after exposure, and necrotic tissues was covered again 263 days after exposure with free latissimus dorsi myocutaneous flap on the left side. Results Degree Ⅳ acute radiation wound on the right thigh had already healed completely with ideal appearance gained, and functionality restored to large extent. Finally, the patient could walk about with the aid of crutch a year after exposure. Conclusions Latissimus dorsi muscle flap has constant vascular anatomy and multi-organizational capacity, and can provide larger area of skin grafts. Both free latissimus dorsi myocutaneous flap and its derived joint myocutaneous flap are applicable for repairing large area of degree Ⅳ acute radiation injury. Also, function and appearance can be achievable, which is worthy of extended uses.