背阔肌分区的解剖及临床应用

目的：从解剖和电生理探讨背阔肌分区的可行性及实用性,以便指导临床应用。方法（1）对10具成人尸体进行背阔肌内的血管和神经解剖,按主要血管,神经的分支分布,将背阔肌分区。（2）利用体表电极记录13例（25侧）健康成人背阔肌不同分区在肩关节运动中的肌电表现,将记录结果进行统计学处理。（3）应用外下区背阔肌岛状肌皮瓣支配范围,为10例行乳房再造,肘关节及胸壁瘢痕创面的修复。结果：（1）背阔肌内的主要血管神经分内,外侧两支,按内,外侧将背阔肌分成内上和外下二区。（2）二区在肩关节运动中的肌电表现不同。（3）分区应用背阔肌肌皮瓣行乳房再造,肘关节及胸部瘢痕创面修复均得满意效果。结论：背阔肌可以分为二区并可分开应用,外下区较内上区有肩关节运动中起的作用大。     

背阔肌分区的基础研究及临床应用的多样性

目的　从解剖和电生理两方面论证背阔肌分区的可行性及实用性 ,以便在临床工作中能更合理地利用背阔肌。方法　 1、对 10具成人尸体进行背阔肌内的血管、神经解剖 ,按主要血管、神经的分支分布 ,将背阔肌分区。 2、利用体表电极记录 13例 (2 5侧 )健康成人背阔肌不同区在肩关节运动中的肌电表现 ,将记录结果进行统计学处理。 3、应用外下区背阔肌岛状肌皮瓣为 10例患者行乳房再造和肘关节及胸壁瘢痕创面的修复。结果　背阔肌内的主要血管神经分内、外侧二支 ,按内、外侧支的分支分布可以将背阔肌分成内上和外下二区。二区在肩关节运动中的肌电表现不同。临床分区应用岛状背阔肌肌皮瓣行乳房再造和肘关节及胸部瘢痕创面修复均取得满意效果。结论　背阔肌可以分为二区并能分开应用。外下区较内上区在肩关节运动中所起的作用大。     

背阔肌节段肌瓣一期修复晚期面瘫的应用解剖

目的 为联合应用背阔肌两块节段肌瓣一期动力矫正晚期面瘫表情肌功能提供解剖学依据.方法 解剖20具10%福尔马林固定的成人尸体共40侧背阔肌标本,醋酸乙酯血管灌注2具新鲜成人尸体共3侧背阔肌标本,观察肌外、肌内神经血管的分布特点.结果 ①92.5%的胸背神经分为内、外侧支;7.5%的胸背神经分为内、中、外侧支.胸背神经内、外侧支分叉点的坐标为(7.94±1.23)em、(3.71±1.68)cm,在该交角的中线区域,神经血管的数量相对较少.②背阔肌外侧肌瓣可以分为3～5个亚单位,内侧肌瓣可以分为2～4个亚单位.③肌内神经血管分支排列关系(由内向外),内侧节段100%为NVAV(神经、静脉、动脉、静脉),外侧节段85.0%为VAVN,其余15.0%为NVAV.④在神经蒂分支点外侧切断,第三段内侧肌瓣神经蒂平均达16 cm,第三或四段外侧肌瓣神经蒂平均达12 cm.结论 吻合血管神经的背阔肌双节段肌瓣移植可一期跨面修复晚期面瘫.     

带肋间神经外侧后支背阔肌感觉皮瓣的应用解剖

目的：为形成带感觉神经的背阔肌游离皮瓣提供解剖学基础,方法：在20具40侧成人躯干标本上,采用大体解剖方法结合4倍显微镜,解剖后背区及侧胸区层次结构,观测分布于背阔肌区域的间神经的来源,走行及分布规律。结果 T5－10神经外侧支的后支在腋前线1－2cm相应间穿出,水平向后背走行较长距离,在肩胛下角线附近浅出皮下,呈节段性,重叠性分布肩胛线以外的背阔肌区皮肤,并与下位胸脊神经后支在肩 胛下 线相吻合,其中T6－8外侧支的后支分支分布于皮瓣范围较大,神经蒂较长并与血管蒂较近,结论：可设计以第6－8肋间神经外侧后支为神经[蒂的背阔肌感觉皮瓣。     

背阔肌肌皮瓣在乳房再造中的应用

目的探讨利用背阔肌肌皮瓣进行乳房再造的设计、手术操作及效果。方法2005年5月至2006年4月行背阔肌肌皮瓣乳房再造18例,其中8例联合假体置入。观察指标包括手术时间、术后并发症及美学效果。结果平均手术时间为147min。再造乳房全部成活,无严重术后并发症。除1例再造乳房位置偏高以外,其余17例（94.4%）患者对再造乳房均很满意。结论背阔肌肌皮瓣或联合假体置入乳房再造操作简便、术后并发症少,再造乳房形态好,是一种可供选择的乳房再造方法。     

扩大背阔肌肌皮瓣乳房再造

目的 介绍单纯应用扩大背阔肌肌皮瓣进行乳房再造方法。方法 将背阔肌周围脂肪组织分为5个区，在背部设计半月形皮肤切口，切取背阔肌及周围脂肪组织，不应用乳房假体，进行即时或后期乳房再造。结果 应用该方法乳房再造35例，再造乳房形态良好，结论 扩大背阔肌肌皮瓣乳房再造，安全有效，再造乳房形态良好，是乳房再造的重要进展。     

背阔肌移位重建伸髋及稳定膝关节

本文报告8例病人用背阔肌移位法重建伸髋及稳定膝关节,文内对手术方法进行了介绍,并着重指出:背阔肌移位后收缩力仍很强大,用以替代一侧臀肌及大腿部肌群严重麻痹患者可以获得较好的治疗效果。     

背阔肌肌瓣转移修复Poland综合征胸部畸形

目的 探讨背阔肌肌瓣转移矫治Poland综合征胸部畸形的方法与注意事项。方法 10例患者采用侧胸垂直切口及腋下小切口切取转移背阔肌肌瓣矫正胸壁畸形,注意腋前皱襞的重建。结果 10例背阔肌肌瓣全部成活,随访1～2年,效果良好。结论 背阔肌肌瓣具有稳定、可靠的血供保证,能提供足够的组织量,是修复Poland综合征胸部畸形的理想方法。     

Endoscopic harvesting of the latissimus dorsi muscle flap

The harvesting of the latissimus dorsi flap is performed usually through a large. skin incision. To avoid the associated large scar a minimally invasive technique has been developed for harvesting the latissimus dorsi muscle. To date, this procedure has been used in eight clinical cases. The advantages of the endoscopic procedure are the decrease of visible scarring and the reduction of morbidity at the donor site.     

Bilateral latissimus dorsi flaps for the reconstruction of extensive scalp defects

BACKGROUND:

The reconstruction of large scalp defects is occasionally required. Several methods of scalp reconstruction have previously been described. This paper presents the authors’ experience with two patients in whom traditional methods were not sufficient and in whom bilateral latissimus dorsi free flaps were required.

OBJECTIVES:

To evaluate the effectiveness of a new technique in reconstructing extensive scalp defects.

METHODS:

Two case histories are presented. These include the rationale for the choice of reconstruction used as well as a discussion on the technical features of the surgery.

RESULTS:

Reconstruction was effective in both cases. However, one patient died in the early postoperative period from a pulmonary embolus.

CONCLUSIONS:

Bilateral latissimus flaps can be safely and effectively used in closing massive scalp defects in selected cases.     

Delayed seroma formation at the latissimus dorsi donor site

Seroma formation is known as the most common complication of reconstruction using the latissimus dorsi muscle flaps. Although the development of a seroma in the immediate or acute postoperative period is a fairly common consequence after latissimus dorsi harvest, it is unusual for a fluid collection to recur several years after the procedure. To the best of our knowledge, there has been no report regarding very late seroma formation in the English literature. Here, we present a delayed development of seroma at the latissimus dorsi donor site of a patient 4.5 years postoperatively.     

Release of severe post-burn axillary contracture with the latissimus dorsi flap

Summary One stage reconstruction of the anterior axillary fold, in a case of severe post-burn axillary contracture, with the island latissimus dorsi musculocutaneous flap is described. Postoperatively the patient had a full range of active abduction and a good cosmetic result.     

保留胸背神经的背阔肌皮瓣游离移植

目的 为减少背阔肌皮瓣切取时供区的代价，尽可能保留肌皮瓣切取后背阔肌的功能。方法 通过了解胸背神经、血管的解剖特点，切取肌皮瓣时不将胸背神经完全切断，保留部分或全部神经的支配。手术前后对背阔肌的神经肌肉动作电位进行检查，了解术后保留的背阔肌功能。临床应用20例修复下肢或前臂软组织缺损或伴骨外露。结果 19例移植皮瓣成活良好，保留的背阔肌有收缩功能存在。结论 在切取一定大小的背阔肌皮瓣时，保留胸背神经的支配，可减小背阔肌的功能损失，使供区的代价降低，符合皮瓣切取原则。     

Reconstruction of the pelvis and perineum with a free latissimus dorsi myocutaneous flap: a case report

Reconstruction of the perineum and pelvic cavity in continuity is an uncommon and difficult challenge. This case describes a 66-year-old man who presented following recurrence of a Dukes’ B rectosigmoid adenocarcinoma that had been treated nine years previously by anterior resection, 5-fluorouracil and radiotherapy. His recurrent disease was treated with radical pelvic exenteration with formation of an end colostomy and urinary ileal conduit.A post-operative pelvic collection necessitated incisional drainage via the perineum. This resulted in a perineal defect in continuity with the pelvic cavity, neither of which healed in spite of alternate day packing with antiseptic dressings. The perineum and cavity were reconstructed successfully with a microvascular transfer of the latissimus dorsi using the primary gracilis pedicle as recipient donor vessels.     

A new approach to the study of latissimus dorsi muscle vasoreactivity in rats

In this paper we describe a new approach to the study of changes in latissimus dorsi (LD) muscle microcirculation in rats. The experiments were carried out under anesthesia in normal male Wistar rats (C, n = 6) and in diabetes-induced rats (D, streptozotocin, 50 mg/kg, i.v., n = 6). The left LD muscle was exposed in order to preserve the proximal tendon with its thoracodorsal nerve and artery. The animal was kept in lateral decubitus over a heating board attached to the mechanical stage of the intravital microscope. The ventral surface of the muscle was exposed over a transparent plate and fixing. The image of the LD vascularization was transferred to the camera system, which was connected to a microcomputer equipped with software (KS-300, Kontron Elektronik, Munich, Germany) for image storage. The vasoreactivity of LD was analyzed by changes in arteriole diameter after topically administered noradrenaline (0.3 microg/ml) and acetylcholine (300 microg/ml). The microscopic image provided by the described optical setup permitted clear resolution of capillary vessels and a stable preparation over a period of 3-4 h. D rats showed increased vasodilatation (29 +/- 2% vs. 18 +/- 2.6% in C) and similar vasoconstriction (25.5 +/- 3% vs. 27.5 +/- 3.3% in C) as compared to C rats. The method described in this paper is suitable for the study of changes in responsiveness of LD arterioles, vessels which represent the major site of vascular resistance and are most actively involved in the control of tissue perfusion.     

Breast volume replacement using the de-epithialized latissimus dorsi myocutaneous flap

Summary The de-epithelialized latissimus dorsi myocutaneous flap can be used for volume replacement of the subcutaneous mastectomy or unilateral hypoplasia, or for the replacement of the contracted prosthetic implant. Acceptable aesthetic results should be expected, and the permanence of the procedure is an improvement over the conventional silicone implant method of breast volume replacement. The procedure is applicable to both obese and thin patients, and should be considered as a reasonable alternative to the other methods of autologous replacement of lost breast tissue.     

Transplantation of a latissimus dorsi flap between identical twins

We present a case of composite tissue transplantation of a latissimus dorsi flap between monozygotic twins. The recipient twin, a 19 year old male, suffered from a complex spinal kyphoscoliosis for which he had undergone multiple previous operations over many years. Soft tissue breakdown on his back causing metalwork exposure had necessitated the removal of his most recent spinal rod. This in turn led to rapid severe deterioration of his spinal deformity and consequent critical impairment of lung function. Robust soft tissue cover was required urgently in order to allow the insertion of a new spinal rod. His previous surgeries and body habitus precluded an adequate autologous reconstruction. Instead, reconstruction using composite tissue transplantation from his identical twin brother was successfully undertaken. We discuss the ethical, psychological and surgical issues involved in this case.