腰背部放射性溃疡的临床治疗

Clinical treatment of lumbodorsal radiotherapy ulcers

目的 总结了 12例腰背部严重放射损伤的临床治疗经验。方法 采用姑息性清创 ,部分切除变性的肋骨或脊突骨 ;然后以局部皮瓣移位修复者 2例、肩胛旁皮瓣修复者 1例、岛状背阔肌肌皮瓣倒转移位修复者 9例。结果 移植的皮瓣、肌皮瓣全部成活 12例 ,占 10 0 % ,溃疡甲级愈合11例 ,占 91 7% ,乙级愈合 1例 ,占 8 3%。结论 采用“姑息性切除法” ,选用血循环丰富的轴型皮瓣和肌皮瓣移植修复 ,能有效地改善血液循环、促进创面愈合 ,特别是应用倒转背阔肌肌皮瓣移植修复是较好的材料。

Objective To summarize our experience in the treatment of 12 cases of severe lumbodorsal radio-therapy ulcers. Methods Of the 12 cases,4 were male and 8 female.The youngest patient was 29 and the oldest was 67 years old.Their injuries were mainly resulted from radiotherapy for costal metastasis of breast cancer,carcinoma of uterus and dorsal skin carcinoma or scar induced by 60 Co γ-rays,deep X-rays or superficial accelerator electrons.Their local accumulative dose was 60-120 Gy.Palliative debridement was performed with partial excision of the ribs and spinous process.And then the defects were repaired with local skin flap in 2 cases,parascapular skin flap in 1 case and island musculocutaneous flap of latissiumus dorsi muscle in 9 cases. Results All the skin flaps and musculocutaneous flaps grafted on the wounds of the 12 cases survived (100%).Grade A healing was achieved in 11 cases of ulcer (91.7%) and grade B healing in 1 cases (8.3%).All the skin flaps and musculocutaneous flaps grafted survived and the ulcers never recurred. Conclusion Severe lumbodorsal radiotherapy injury often results in complications.We performed palliative excision and repaired by transferring an axial skin flap or a musculocutaneous flap with good blood circulation selected in accordance with the principles of plastic surgery,which can effectively improve blood circulation and promote wound healing.Reverse musculocutaneous flap of latissiumus dorsi muscle is an especially good material for reconstruction.It has axial blood vessel and proper thickness.It is broad and can be rotated with great range and the donor site can be sutured directly. ;