带蒂背阔肌Kiss皮瓣修复肿瘤切除术后胸壁皮肤软组织缺损的临床研究

APPLICATION OF PEDICLED LATISSIMUS DORSI KISS FLAP TO REPAIR CHEST WALL SKIN DEFECTS AFTER TUMOR RESECTION

目的探讨带蒂背阔肌Kiss皮瓣修复肿瘤切除术后胸壁皮肤软组织缺损的疗效。方法 2010年12月-2015年12月,收治15例胸壁肿瘤患者。男2例,女13例;年龄43~60岁,平均51.8岁。局部晚期乳腺癌11例,胸壁皮肤纤维肉瘤3例,胸壁放射性溃疡1例。病程6个月~8年,中位时间24.1个月。术中切除原发灶后,胸壁皮肤软组织缺损范围达17 cm×12 cm^20 cm×18 cm;采取带蒂背阔肌Kiss皮瓣移位修复创面,A、B两瓣大小相等,单个皮瓣切取范围为17 cm×6 cm^20 cm×9 cm;供区直接拉拢缝合。结果术后14例皮瓣顺利成活,创面Ⅰ期愈合;1例皮瓣远端坏死,经换药后延期愈合。供区切口均Ⅰ期愈合。患者均获随访,随访时间6个月~3年,平均21.6个月。术后皮瓣外观良好,蒂部无臃肿,对肩关节活动无明显影响。肿瘤患者均无局部复发,2例乳腺癌患者发生远处转移。供区切口遗留线性瘢痕。结论应用带蒂背阔肌Kiss皮瓣修复胸壁皮肤软组织缺损,手术操作简便,供区损伤小,术后恢复快,为后续治疗争取了时间。

Objective To investigate the clinical value of pedicled latissimus dorsi Kiss flap in repairing chest wall large skin defect after tumor operation. Methods A retrospective analysis was made on the clinical data from 15 cases of chest wall tumors treated between December 2010 and December 2015. There were 2 males and 13 females with an average age of 51.8 years （range, 43-60 years）; there were 11 cases of locally advanced breast cancer, 3 cases of fibrosarcoma in chest wall, and 1 case of chest wall radiation ulcer with a median disease duration of 24.1 months （range, 6 months to 8 years）. The area of skin defects was 17 cm×12 cm to 20 cm×18 cm after primary tumor resection; the pedicled latissimus dorsi Kiss flap was designed to repair wounds. The flap was a two-lobed flap at a certain angle on the surface of latissimus dorsi based on the thoracodorsal artery, with a size of 17 cm×6 cm to 20 cm×9 cm for each lobe. The donor site was sutured directly. Results Fourteen flaps survived with primary healing of wound; delayed healing was observed in 1 flap because of distal necrosis; and healing by first intention was obtained at the donor sites. The follow- up time was from 6 months to 3 years （mean, 21.6 months）. The flap had good appearance with no bloated pedicle. The shoulder joint activities were normal. No local recurrence occurred, but distant metastasis in 2 cases. No obvious scar was found at donor sites. Conclusion The application of pedicled latissimus dorsi Kiss flap to repair chest wall skin defects after tumor resection has important clinical value, because of the advatages of simple operation, minor donor site damage and rapid postoperative recovery, especially for late stage cancer patients.