不同闭合方式的背阔肌肌皮瓣移植术后供区并发症的分析

Analysis of donor site complications after latissimus dorsi flap transplantation with different closure methods

目的 分析不同供区闭合方式的背阔肌肌皮瓣术后供区并发症发生情况。方法 回顾性分析自2017年6月至2020年6月,苏州瑞华骨科医院手外科收治的52例背阔肌肌皮瓣手术患者。其中游离背阔肌肌皮瓣30例,带蒂转移背阔肌肌皮瓣22例;修复创面43例,行肢体功能重建9例,皮瓣面积10 cm×4 cm~43 cm×15 cm,手术时间2.0~10.5 h。按照供区闭合方式分为直接缝合组(36例)和植皮组(16例),比较两组供区并发症发生情况。结果 所有患者获随访6~38个月。其中缝合组13例“蜈蚣足”样增生瘢痕;2例血肿;2例部分切口裂开;1例感染;1例瘢痕挛缩。植皮组7例贴肌肉瘢痕;5例“蜈蚣足”样增生瘢痕;4例血肿;4例植皮坏死;3例凹陷畸形;1例瘢痕挛缩;1例肩关节功能障碍。不同供区闭合方式的供区并发症中,血肿、感染、伤口裂开、活动障碍发生率比较,差异无统计学意义(P>0.05);缝合组在异常瘢痕、凹陷畸形发生率上小于植皮组,差异有统计学意义(P<0.05)。结论 通过减少不必要的植皮及切口减张美容缝合等方法可以有效地预防并发症的发生。

Objective To analyze the postoperative complications of latissimus dorsi myocutaneous flap with different donor site closure methods. Methods Retrospective analysis from June 2017 to June 2020, 52 patients with latissimus dorsi myocutaneous flap were treated in Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital. Including free latissimus dorsi myocutaneous flap in 30 cases, pedicled latissimus dorsi myocutaneous flap in 22 cases, wound repair in 43 cases and limb function reconstruction in 9 cases. The flap area was 10 cm×4 cm~43 cm×15 cm and the operation time was 2.0~10.5 h. Direct suture was performed in 36 cases and skin grafting in16 cases. According to the closing mode of the donor area, the patients were divided into direct suture group and skin grafting group, and the complications of the two groups were compared. Results All patients were followed up for 6 to 38 months. the complications in the direct suture group were hematoma in 2 cases, infection in 1 case, partial incision dehiscence in 2 cases, centipede hyperplastic scar in13 cases, scar contracture in 1 case. The complications in the skin grafting group were hematoma in 4 cases, skin graft necrosis in 4 cases,centipede foot hyperplasia in 5 cases, muscle scar in 7 cases, scar contracture in 1 cases, shoulder dysfunction in 1 cases and depressed deformity in 3 cases. There was no significant difference in the incidence of hematoma, infection, wound laceration and dyskinesia among the complications of different donor site closure methods(P>0.05). The incidence of abnormal scar and sunken deformity in the suture group was lower than that in the skin graft group(P<0.05). The difference was statistically significant(P<0.05). Conclusion The complications can be effectively prevented by reducing incision tension and cosmetic suture. Reducing unnecessary skin grafting can effectively prevent the occurrence of complications.