肩周穿支蒂岛状皮瓣联合修复中老年胸部巨大软组织缺损

Repair of large soft tissue defect in middle and old aged breast with island flap pedicled with shoulder perforating branch

目的介绍应用肩周穿支蒂岛状皮瓣联合修复中老年胸部巨大软组织缺损的方法。方法 2009年3月-2016年3月共收治3例因机器挤轧致胸部外伤,男2例,女1例,年龄49～64岁,平均54岁,病程平均34 d。均在外院行胸腔闭式引流及肋骨骨折内固定,病情稳定均因胸前壁巨大软组织缺损转入我院,给予术前准备、胸外科会诊,待创面稳定及身体状况许可后,择期行扩创、联合岛状皮瓣重建胸壁前软组织。结果 3例患者均顺利完成联合岛状皮瓣修复胸前壁创面手术,术后恢复良好,创面均Ⅰ期愈合。术后患者未出现胸闷等不适症状,胸廓未见反常呼吸。拆线观察1周后,未见创面明显红肿及渗出,平均住院34 d痊愈出院。结论肩周穿支蒂岛状皮瓣联合修复中老年胸部巨大软组织缺损避免了因年纪较大而采用游离皮瓣修复创面的风险性,是一种较为安全、实用、有效的治疗方法 。

Objective To introduce a method for repairing large soft tissue defect of middle and old aged patients with shoulder island flap. Methods From March 2009 to March 2016, 3 cases of chest injuries due to machine crush injuries were treated, including 2 males and 1 female, aged 49-64 years, with an average age of 54 years, with an average duration of about 34 days （3 years）. Both closed thoracic drainage and rib fracture fixation in each patient was performed in other hospital, after condition was stable the patients were transferred to our hospital department due to massive defect on chest wall, given preoperative preparation, consultation, after physical conditions permitted selective debridement combined with island flap was used to repair soft tissue chest wall. Results All of the 3 patients completed the repair of the wound on the chest wall successfully with the combined island flap. The wound healed well and the wound healed at the same time. No discomfort such as chest distress occurred in the patients, and no abnormal breathing was found in the thorax. After 1 week of observation, no obvious redness and swelling were found. The average hospital stay was 34 days, and the patient was discharged from the hospital. Conclusion Shoulder perforator pedicled island flap in repairing senile thoracic massive soft tissue defect can avoid the risk of free flap due to the old age, which is a safe, practical and effective method of treatment.