前锯肌肌筋膜瓣移植修复足背大面积软组织缺损的临床效果

Repair of large area soft tissue defect on dorsal side of the foot by serratus anterior myofascial flap transplantation

目的总结前锯肌肌筋膜瓣移植修复足背大面积软组织缺损的临床应用效果。方法选择2015年1月至2019年1月,甘肃省兰州市兰州手足外科医院手外科应用前锯肌肌筋膜瓣移植修复足背大面积软组织缺损患者16例,其中,男11例,女5例;年龄24~50岁,平均(36.6±5.3)岁;软组织缺损范围为13 cm×8 cm^9 cm×6 cm。肌筋膜瓣切取连带肩胛下与旋肩胛血管,血管蒂近端呈“T”形,与受区胫前动脉两断端行端端吻合,肌筋膜瓣上用中厚网状游离植皮覆盖,供区创面直接缝合。结果术后肌筋膜瓣全部成活,随访1.2~4.5年,平均(3.4±2.3)年,受区和供区外形较好,优9例,良6例,可1例,优良率为93.75%,取得了较满意的效果。结论前锯肌肌筋膜瓣移植手术操作安全、可靠,适于修复足背大面积软组织缺损,降低了对受区主要血管的损伤。

Objective To assess the clinical effects of repair of large area soft tissue defect on the dorsal side of the foot by serratus anterior myofascial flap transplantation.Methods Between January 2015 and January 2019,16 patients with large area soft tissue defect on the dorsal side of the foot were treated by serratus anterior myofascial flap transplantation.There were 11 males and 5 females,aged from 24 to 50 years,mean of(36.6±5.3)years.The size of the soft tissue defect ranged from 13 cm×8 cm to 9 cm×6 cm.A serratus anterior myofascial flap was harvested with subscapular and circumflex scapular arteries forming a T-shaped vascular pedicle.The T-shaped vascular pedicle of the serratus anterior myofascial flap was anastomosed to the two ends of the anterior tibial artery at the recipient site by end-to-end anastomosis.Coverage of the myofascial flap was performed with a meshed split-thickness skin graft.Results All myofascial flaps survived completely.The patients were followed up for 1.2-4.5 years,with average of(3.4±2.3)years.A good contour was confirmed at the recipient and donor sites.The outcomes were excellent in nine patients,good in six,and fair in one,with an excellent or good rate of 3.75%.Satisfactory clinical results were achieved in this series.Conclusion This technique is safe,reliable,and particularly suitable for repairing large area soft tissue defect on the dorsal side of the foot and reducing the damage to main vessels of the recipient site.