背阔肌肌皮瓣窗瓣修复头部大面积缺损

Clinical application of modified latissimus dorsi-myocutaneous in the repair of large scalp defect

目的 探讨改良背阔肌肌皮瓣修复头部大面积缺损的临床疗效。方法 采用改良的游离背阔肌肌皮瓣移植修复头部大面积缺损患者6例,其中1例为慢性溃疡,5例为鳞状细胞癌;肿瘤扩大切除后形成的最大创面面积为20 cm×21 cm。相较于传统的背阔肌皮瓣切取后需要供区植皮覆盖创面的方法,改为肌瓣表面携带部分皮瓣作为观察窗的切取方法,皮瓣大小以供区能够拉拢缝合为宜。肌皮瓣切取最大面积为22 cm×23 cm,表面携带部分皮瓣形成观察窗,以便观察血供情况,其余肌瓣表面行植皮覆盖;侧胸背部皮瓣供区直接拉拢缝合。结果 6例患者的移植皮瓣均成活良好,修复效果满意。皮瓣供区伤口均一期愈合,仅遗留线性瘢痕。结论 采用改良的游离背阔肌肌皮瓣移植修复头部大面积缺损,可避免皮瓣供区植皮,减轻传统术式带来的皮瓣供区继发畸形。

Objective To explore the clinical application of modified latissimus dorsi myocutaneous flaps in the repair of large scalp defects. Methods From January 2012 to March 2017, 6 patients with large scalp defects underwent repair with modified latissimus dorsi-myocutaneous flaps. Pathological results showed that one patient had a chronic ulcer, the others had squamous cell carcinoma. The largest defect area after tumor dissection was 20 cm × 21 cm. Instead of the traditional harvesting method in which the donor skin graft covers the wound, a new method was adopted in which the muscle flap was carried with the partial flap on the surface and used as an observation window. The size of the flap was suitable for the donor area to be closed and sutured. The maximum area of myocutaneous flap was 22 cm × 23 cm, with part of the skin flap on the surface to observe the blood supply. The rest of the muscle flaps were covered with skin grafts. The donor site of the lateral thoracic dorsal flap was closed and sutured directly. Results All flaps survived well and the efficacy of the repair was satisfactory. The flap donor site healed primarily, and only the linear scar was left. Conclusion The modified latissimus dorsi myocutaneous flap is an ideal option for large scalp defect repairs. It allows the surgeon to avoid skin grafting of the donor site,and significantly reduces secondary deformity of the donor site typically brought about by the traditional method.