Flow-through背阔肌肌皮瓣修复儿童四肢创面

Application of Flow-through latissimus dorsi musculocutaneous flap to repair the wounds in children’s limb

目的探讨应用Flow-through背阔肌肌皮瓣修复儿童四肢创面的手术方法及临床疗效。方法2017年1月至2019年9月,应用Flow-through的背阔肌肌皮瓣修复儿童四肢创面9例,其中上肢3例,下肢6例;年龄5~12岁,平均9.4岁;I期行创面清创,负压海绵封闭创面,5~8 d后II期应用Flow-through游离背阔肌肌皮瓣修复创面,6例患者结合植皮修复创面。术中受区动脉两端均修整为管腔向下的斜面,受区血管近端和肩胛下动脉吻合,远端和旋肩胛动脉吻合,胸背静脉和受区静脉吻合。8例患者有1条胸背静脉,1例患者有2条胸背静脉。术后常规抗感染、抗凝血和抗血管痉挛治疗,并定期随访。结果本组中8例皮瓣完全成活,1例远端部分表皮坏死,后痂下愈合。植皮成活良好。术后9例均获得随访,随访时间3~28(平均13)个月,术后门诊随访7例,微信随访2例。所有患者术后1个月CDU检查提示血流通畅,3例术后1年随访CDU检查提示血流通畅。皮瓣血运良好,质地柔软,3例后期行皮瓣整形手术。结论应用Flow-through背阔肌肌皮瓣修复儿童四肢创面,皮瓣成活良好,受区主干血管血流通畅,对肢体远端血供无明显影响。

Objective To explore the method and clinical efficacy of Flow-through latissimus dorsi musculocutaneous flap to repair children’s limb wounds.Methods From January,2017 to September,2019,the Flow-through latissimus dorsi myocutaneous flap was used to repair the limb wounds in 9 children,which were 3 cases of upper extremity wounds and 6 cases of lower extremity wounds.The patients were 5-12 years old,with an average age of 9.4 years.The wound debridement was performed in the first stage,and the wound was covered with VSD.The second operation was performed 5-8 days later.Flow-through free latissimus dorsi muscle flap was used to repair the wound,and 6 patients combined with skin grafting.During the operation,both ends of the recipient area artery were trimmed into a downward slant.The proximal end of the recipient area blood vessel was coincided with the subscapular artery,the distal end was coincided with the circumflex scapular artery,and the thoracodorsal vein and the recipient area vein were coincided.One patient had 2 thoracodorsal veins,and 8 patients had 1 thoracodorsal vein.After the operation,the patients were given anti-infection,anticoagulation and antispasmodic treatment.And regular follow-up.Results In this group,8 flaps survived completely,and 1 had partial epidermal necrosis,which healed under the scab.Skin grafting survives well.Nine patients were followed-up for 3 to 28 months,7 of which were followed-up in the outpatient clinic,and 2 by WeChat.CDU showed smooth blood flow in all patients 1 month after operation,in addition of 3 after 1 year.The flap had good blood flow and soft texture.Flap plastic surgery was performed in 3 cases.Conclusion Using Flow-through latissimus dorsi musculocutaneous flap to repair the wounds of the children’s limbs,the flap survived well after the operation,and the blood circulation of the main vessel in the affected area was smooth,which had no obvious effect on the blood supply to the distal limb of the affected area.