超大面积前背阔肌皮瓣联合腹直肌皮瓣移植术

目的 探讨超大面积的前背阔肌皮瓣联合腹直肌皮瓣移植术的应用价值和手术技巧.方法 对2005年5月至2007年1月实施手术的3例患者进行随访,随访时间为10～40个月,平均24.7个月.其中男性2例,女性1例,3例患者均有皮肤缺损伴骨裸露.创面创伤性皮肤缺损1例,肿瘤切除导致皮肤缺损2例,皮瓣面积分别是:60cm×32 cm,55 cm×30 cm和50 cm×25 cm,皮瓣应用形式:带双血管蒂游离移植1例,一端带蒂一端游离移植1例,两端均带蒂移植1例.结果 皮瓣完全成活2例,皮瓣边缘小部分坏死1例,经换药后愈合.创面感染均得到有效控制,为功能恢复创造了条件.1例创伤患者骨折愈合,完全负重行走,恢复原有工作.结论 前背阔肌皮瓣联合腹直肌皮瓣移植术能够一次性修复体表较大面积皮肤缺损,而且效果满意.

Transplantation of large anterior latissimus dorsi muscular flap combination with musculus rectus abdominis flap

Objective To study the value and surgical techniques of transplantation of large anterior latissimus dorsimuscular flap combination with musculus rectus abdominis flap. Methods Three cases (2 male and 1 female) with skin defect and bone exposed were reviewed from May 2005 to January 2007. Two patients suffered from trauma, and 1 suffered from tumor resection. Flaps size were: 60 cm ×32 cm, 55 cm × 30 cm and 50 cm× 25 cm, flaps pattern including: 1 free flap with 2 ends of vascular, 1 flap with pedicle and free vascular end, 1 flap with 2 ends of pedicle. Results Two flaps survived completely, 1 flap with necrosis edge eventually healed after change of dressing. The infection had been effectively controlled and ready for function recovered. One case caused by trauma recovered with fracture healing, full weight-bearing and restore the original work. Conclusions Large anterior latissimus dorsi muscular flap combination with musculus rectus abdominis flap can be used for repair of large skin defect. For the difficulty and technical requirements, surgical indications should be strictly controlled.