T形血管蒂背阔肌肌皮瓣桥式移植修复小腿软组织缺损

Repair of soft tissue defects in lower extremities by latissimus dorsi myocutaneous flap with T type of vascular pedicle

目的探讨T形血管蒂背阔肌肌皮瓣桥式移植在小腿软组织缺损中的应用。方法2003年1月至2013年8月收治16例小腿皮肤软组织缺损患者，均采用T形血管蒂背阔肌肌皮瓣桥式移植的方法修复。将肩胛下血管近端及旋肩胛血管远端嵌入健侧断开的胫后血管中，行端端吻合，胸背血管蒂通过健侧皮管桥，将背阔肌肌皮瓣覆盖患侧小腿创面，双小腿调整至合适位置后外固定架固定。结果术后3例出现血管危象，行血管探查后解除危象；2例皮瓣边缘存在浅表感染，经3周换药后好转；其余11例移植组织在术后2周全部一期愈合。术后均获6个月至5年随访，平均3．4年。移植皮瓣外形良好，肢体功能基本恢复。结论在患肢无法提供可供吻合的血管时，T形血管蒂背阔肌肌皮瓣桥式移植修复小腿软组织缺损，是一种行之有效的方法，且不牺牲健侧肢体主干血管。

Objective To investigate the Application of latissimus dorsi myocutaneous flap with T type of vascular pedicle in repairing soft tissue defects at lower extremities. Methods Between January 2003 and August 2013, 16 patients with skin and soft tissue defects at lower extremities were treated with T type vascular pedicled latissimus dorsi myocutaneous flap through bridge transplantation. There were 13 male and 3 female patients with an average age of 36.2 years（ range , 17 - 54 years ）. Skin and soft tissue defects in the lower extremities ranged from 18 cm × 13 cm to 32 cm ×15 cm. The T - configuration vascular anastomosis was formed by anastomosing the subscapular and circumflex scapular vessels to the proximal and distal ends of the posterior tibial vessel broken in the normal leg respectively in an end-to-end manner. The latissimus dorsi myocutaneous flap was used to cover the defect at damaged leg where vascular pedicle was wrapped by tube flap from the normal leg. External fixators was used to immobilize the bilateral lower legs postoperatively. Results Vascular crisis occurred in 3 cases. Vascular crisis was relieved after exploring the vessel. 2 cases developed infection at the distal end of flap and cured by debridement. Primary healing was obtained in 11 cases after 2 weeks, and the total survival rate was 100%. The follow- up period lasted for 6 months to 5 years with an average of 3.4 years. The flap appearance was satisfactory and extremity function was restored to normal. Conclusions The application of the T type of vascular pedicled latissimus dorsi myocutaneous flap by bridge transplantation is an effective method for repair skin and soft tissue defects in lower extremity without damaging for main blood vessels at contralateral limb, when affected extremities have no available vessel for anastomosis.