折叠式带蒂背阔肌肌皮瓣在肩背部软组织缺损创面修复的初步应用

Preliminary application of foldable pedicled latissimus dorsi myocutaneous flap for repairing soft tissue defects in shoulder and back

目的探讨折叠式带蒂背阔肌肌皮瓣应用于肩背部软组织缺损创面修复的可行性和临床效果。方法2018年8月—2023年1月,应用折叠式带蒂背阔肌肌皮瓣修复8例肩背部软组织缺损创面。其中男5例,女3例;年龄21~56岁,平均35.4岁。创面位于肩部2例,肩背部6例。致伤原因:皮肤慢性感染骨外露2例,皮肤软组织肿瘤扩大切除后继发创面4例,交通事故伤致创面形成2例。皮肤缺损范围为14 cm×13 cm~20 cm×16 cm。病程12 d~1年,中位病程6.6个月。设计并切取以胸背动脉为蒂的背阔肌肌皮瓣,将其分为A、B两瓣折叠后修复创面,皮瓣供区均一期拉拢缝合。结果术后7例皮瓣成活,创面Ⅰ期愈合;1例皮瓣远端坏死,经换药后延期愈合。所有供区切口均Ⅰ期愈合。8例患者均获随访,随访时间6个月~4年,平均24.7个月。皮瓣外形好,皮瓣及蒂部无臃肿。末次随访时6例患者双侧肩关节运动无明显差别,2例外展运动范围较健侧稍减小。患者日常生活均未受影响,供区切口遗留线性瘢痕。结论应用折叠式带蒂背阔肌肌皮瓣修复肩背部软组织缺损创面,手术操作简单,供区损伤小,术后恢复快,是一种较为理想的方法。

Objective To explore the feasibility and effectiveness of a foldable pedicled latissimus dorsi myocutaneous flap to repair soft tissue defects in the shoulder and back.Methods Between August 2018 and January 2023,the foldable pedicled latissimus dorsi myocutaneous flaps were used to repair soft tissue defects in the shoulder and back of 8 patients.There were 5 males and 3 females with the age ranged from 21 to 56 years(mean,35.4 years).Wounds were located in the shoulder in 2 cases and in the shoulder and back in 6 cases.The causes of injury were chronic infection of skin and bone exposure in 2 cases,secondary wound after extensive resection of skin and soft tissue tumor in 4 cases,and wound formation caused by traffic accident in 2 cases.Skin defect areas ranged from 14 cm×13 cm to 20 cm×16 cm.The disease duration ranged from 12 days to 1 year(median,6.6 months).A pedicled latissimus dorsi myocutaneous flap was designed and harvested.The flap was divided into A/B flap and then were folded to repair the wound,with the donor area of the flap being pulled and sutured in one stage.Results All 7 flaps survived,with primary wound healing.One patient suffered from distal flap necrosis and delayed healing was achieved after dressing change.The incisions of all donor sites healed by first intention.All patients were followed up 6 months to 4 years(mean,24.7 months).The skin flap has a good appearance with no swelling in the pedicle.At last follow-up,6 patients had no significant difference in bilateral shoulder joint motion,and 2 patients had a slight decrease in abduction range of motion compared with the healthy side.The patients’daily life were not affected,and linear scar was left in the donor site.Conclusion The foldable pedicled latissimus dorsi myocutaneous flap is an ideal method to repair the soft tissue defect of shoulder and back with simple operation,less damage to the donor site,and quick recovery after operation.