游离背阔肌双叶皮瓣修复肢体软组织缺损的效果

The effect of free latissimus dorsi bilobate flaps in reparing limb soft tissues defects

目的探讨游离背阔肌双叶皮瓣修复肢体软组织缺损的效果。方法采用游离背阔肌双叶皮瓣修复9例肢体严重创伤患者,胸背动脉外侧分支背阔肌皮瓣切取范围为13.5 cm×6.5 cm~23.5 cm×9.0 cm,胸背动脉内侧分支背阔肌皮瓣切取范围为6.5 cm×5.5 cm~10.5 cm×7.5 cm。皮瓣切取后进行适当调整以修复各种不规则的缺损创面,皮瓣供区创面可直接缝合或仅需少量皮片移植修复。结果患者均获得随访,时间6~23个月。术后8例游离背阔肌双叶皮瓣全部成活,1例胸背动脉内侧支背阔肌皮瓣远端少部分坏死,经二期切除缺损创面直接缝合后愈合。7例因皮瓣臃肿行皮瓣修薄术,2例无需二次修整。末次随访时9例皮瓣质地及外形均良好,创伤肢体活动功能均恢复满意。7例供区直接缝合,遗留线状瘢痕,2例供区少量皮片移植修复。结论背阔肌皮瓣解剖恒定,血运可靠,供区隐蔽,切取面积范围大,是修复肢体严重创伤大面积软组织缺损的良好方法,而且采取双叶切取既有利于供区创面直接缝合,又有利于不规则创面的修复。

Objective To investigate the effect of free latissimus dorsi bilobate flap in repairing severe limb trauma.Methods The 9 patients with limb severe trauma were repaired with free latissimus dorsi bilobate flap.The incision range of the lateral branch of thoracic dorsal artery was 13.5 cm×6.5 cm~23.5 cm×9.0 cm,and the incision range of the medial branch of thoracic dorsal artery latissimus flap was 6.5 cm×5.5 cm~10.5 cm×7.5 cm.After cutting the flaps,various irregular defect wounds could be repaired by proper deformation.The defect wounds in the donor area of the flap could be repaired by direct suture or only few skin graft.Results All patients were followed up for 6~23 months.After operation,all 8 cases of free latissimus dorsi bilobate flaps survived,and 1 case of dorsal thoracic artery medial branch of latissimus dorsi flap had a small portion of distal necrosis.Skin flap thinning was performed in 7 cases due to bloated skin flap,and no secondary trimming was required in 2 cases.At the last follow-up,the texture and shape of the 9 cases of skin flap were good,and the movement and function of the injured limbs were restored satisfactorily.The donor area was sutured directly in 7 cases,linear scar was left,and few skin graft was repaired in 2 cases.Conclusions It is a good method to repair large defect wounds of severe limb trauma with constant anatomy,reliable blood flow,concealed donor area and large incision area.Double-leaf incision is beneficial to the direct closure of donor area wounds and the repair of various irregular wounds.