带蒂背阔肌皮瓣修复锁骨区恶性肿瘤切除术后皮肤软组织缺损

Application of pedicled latissimus dorsi musculocutaneous flap to repair skin and soft tissue defect after resection of clavicle region malignant tumor

目的探讨带蒂背阔肌皮瓣在修复锁骨区恶性肿瘤切除术后皮肤软组织巨大缺损的疗效。方法对2015年11月-2018年1月收治的9例锁骨区恶性肿瘤患者,术前常规穿刺病检,病检结果证实后手术扩大切除,切除后所形成的巨大缺损创面采用带蒂背阔肌皮瓣进行修复。结果术后经15~24个月随访,皮瓣全部成活,供区均一期愈合。近、远期随访肿瘤均未复发,皮瓣不臃肿,质地与周围组织一致,无溃疡形成,无明显的凹陷畸形,外观满意,肩关节功能恢复良好。结论背阔肌皮瓣血供丰富,供区隐蔽,修复创面效果好,靠近锁骨区,旋转方便,操作简单,是修复肩前锁骨区恶性肿瘤扩大切除术后皮肤软组织缺损的较好方法。

Objective To investigate the effect of pedicled latissimus dorsi musculocutaneous flap on repairing the massive defect of skin and soft tissue after resection of malignant tumor in clavicle region.Methods From November 2015 to January 2018,9 patients with malignant clavicle tumors were enrolled,including 3 cases of malignant fibrous histiocytoma,2 cases of cutaneous fibrosarcoma protuberans,1 case of rhabdomyosarcoma,1 case of cutaneous squamous cell carcinoma,and 2 cases of cutaneous basal cell carcinoma.Routine puncture examination was performed preoperatively,and after the examination results confirmed that the specimen was malignant,the exterded resection was performed.The large defect formed after resection was repaired with pedicled latissimus dorsi myocutaneous flap.Results After 15-24 months follow-up,all the flaps survived and all the donor flaps healed in the first stage.During the recent and long-term follow-up,the tumor did not recur,the skin flap was not bloated,the texture was consistent with the surrounding tissues,and there was no ulcer formation or obvious depression deformity.The appearance was satisfactory,and the function of the shoulder joint recovered well.Conclusion The latissimus dorsi musculocutaneous flap has rich blood supply,hidden donor area,good repair effect,close to the clavicle area,convenient rotation,simple operation,is a good method to repair the skin and soft tissue defect after the extended resection of malignant tumor in the clavicle area of the anterior shoulder.