带蒂联合皮瓣移植修复上肢广泛软组织缺损

目的 探讨上肢广泛软组织缺损皮瓣修复方法的选择.方法 12例肘部、前臂及腕掌部高压电烧伤、热压伤及碾压伤患者,清创后4例应用背阔肌肌皮瓣与髂腰部皮瓣联合修复,将背阔肌肌皮瓣部分形成岛状,胸背血管蒂通过腋窝,上臂内侧皮下,髂腰部皮瓣部分以旋髂浅血管为蒂,皮瓣的蒂部形成皮管,位于腹股沟处,3周后再行断蒂;2例背阔肌肌皮瓣与侧胸皮瓣联合,将胸背动静脉游离出置于侧胸皮瓣内后形成皮管.蒂部位于侧胸上部;6例以巨大胸腹部联合皮瓣带蒂转移修复,以脐旁血管及肋间血管外侧皮支为轴,形成巨大皮瓣包绕前臂环形创面.结果 1例皮瓣远端局限坏死2 cm及皮瓣下感染,余全部成活,效果满意.结论 上肢创伤广泛软组织缺损,早期清创,应用带蒂联合皮瓣、肌皮瓣修复是一种简单、安全、可靠的方法.

Repair of large defects in upper extremities with pedicled combined flap

Objective To explore the flap transposition for repairing large defects in upper extremities.Methods 12 cases with large defects in elbow,forearm,wrist or palm caused by high-voltage electricity,hotpressure or crush,were treated.4 cases were treated with iatissimus dorsal myocutaneous flaps combined iliolumbar flaps.2 cases were treated with latissimus dorsal myocutaneous flaps combined lateral thoracic flaps.6 cases were treated with large combined thoracic-abdomen flaps.Results All the flaps survived except for one flap with 2 cm distal necrosis and sub-flap infection.Satisfactory results were achieved,Conclusions Early debridment and reconatruction with pedicled combined flaps are feasible and reliable for large defects in the upper extremities.