阔筋膜张肌肌皮瓣修复腹股沟区电击伤创面

皮片、大网膜及部分肌皮瓣移植修复腹股沟区组织缺损 ,通常侧重于创面覆盖 ,其加强腹壁薄弱区的作用甚微 ,易出现腹壁疝。笔者于 1987～ 1999年应用阔筋膜张肌肌皮瓣修复 5例腹股沟区电击伤扩创后组织缺损创面 ,取得了较好的临床效果 ,报告如下。资　料　与　方　法1.临床资料     

带蒂组织瓣转位治疗肿瘤性腹壁巨大缺损

目的　报道肿瘤性腹壁巨大缺损的分区评估和应用带蒂组织瓣进行修复的临床效果。　方法　回顾 1992年 10月～ 2 0 0 1年 9月间收治的腹壁恶性肿瘤切除后 ,遗留巨大缺损 8例 ( 10cm× 10cm～ 32cm× 32cm)。按照腹壁分区 ,Ⅰ区缺损 2例 ,双Ⅱ区缺损 2例 ,Ⅲ区缺损 2例 ,一侧Ⅰ、Ⅱ区同时缺损 1例 ,近全腹壁肌肉缺损 1例。手术转位组织瓣 11块 ,其中股薄肌皮瓣 4块 ,腹直肌皮瓣 2块 ,腹外斜肌筋膜瓣 2块 ,背阔肌、阔筋膜张肌和股直肌瓣各 1块。 1例同时使用了e PTFE软组织补片。　结果　 8例切口均一期愈合 ,组织瓣全部成活 ,3周内全部下地活动。随访平均 2年 5个月 ,腹壁重建成功。　结论　腹壁分区有利于对缺损的评估和供区的选择 ,带蒂组织瓣转移是重建腹壁的有效方法。     

应用腹直肌前鞘-腹外斜肌腱膜瓣修复先天性膀胱外翻

目的总结先天性膀胱外翻的修复,探讨腹直肌前鞘—腹外斜肌腱膜瓣及肌蒂阔筋膜张肌肌皮瓣在修复膀胱外翻中的应用。方法应用腹直肌前鞘—腹外斜肌腱膜形成的前鞘—腱膜瓣加局部皮瓣或同侧肌蒂阔筋膜张肌肌皮瓣修复先天性膀胱外翻及腹壁缺损,局部皮瓣修复尿道上裂,肌皮瓣的应用面积最大为10cm×8cm。结果临床应用12例,膀胱外翻及腹壁的修复均达到了良好效果,膀胱括约肌功能基本恢复,二次尿道紧缩后12例均能控制排尿。肌蒂阔筋膜张肌肌皮瓣部分坏死2例,游离植皮后痊愈。结论选择性地应用腹直肌前鞘及腹外斜肌腱膜形成前鞘—腱膜瓣加强腹壁,局部皮瓣转移或应用同侧肌蒂阔筋膜张肌肌皮瓣转移修复腹壁缺损能有效地修复先天性膀胱外翻,恢复膀胱颈部括约肌的连续性及尿道紧缩,能达到自主控制排尿的目的。     

先天性膀胱外翻腹壁缺损的整形外科修复

目的:探讨修复先天性膀胱外翻腹壁缺损的常用整形外科方法及适应证选择。方法:2004年6月-2014年6月,利用整形外科原则分析先天性完全性膀胱外翻的腹壁组织缺损范围和程度,分别应用腹壁局部肌筋膜瓣、阔筋膜张肌皮瓣、阴股沟皮瓣及髂腹股沟皮瓣修复先天性完全性膀胱外翻腹壁缺损患者共18例,男13例,女5例,首次手术者14例,曾接受过失败的修复手术者4例,患者年龄1岁2个月~34岁,平均年龄14.6岁。皮瓣面积:4cm×3cm~10cm×10cm。结果:15例患者腹壁缺损一期愈合,修复效果满意,皮瓣成活良好,3例采用带蒂阔筋膜张肌肌皮瓣修复者出现皮瓣部分坏死或愈合不良,其中2例经游离植皮后痊愈,1例表皮坏死通过换药后愈合。本组18例患者平均随访36个月(6~72个月),全部患者外翻的膀胱得到还纳,腹壁缺损得以修复,腹部外形和排尿功能恢复较为满意。结论:针对不同年龄和腹壁缺损程度的患者,选择性使用整形外科皮瓣尽早闭合完全性膀胱外翻腹壁缺损,效果肯定,术后形态满意,在一定程度上恢复了患者自主排尿功能,提高了患者的生活质量。     

胸脐皮瓣作衬里修复上腹壁穿透性缺损1例

较大面积腹壁穿透性缺损修复比较困难,尤其是位于上腹部缺损,无法利用阔筋膜张肌等股部肌皮瓣修复.我院于1996年7月对1例上腹正中腹壁种植转移结节性腺癌行癌肿切除后,在上腹正中部形成12cm×12cm腹壁全层穿透性缺损,利用左侧胸脐皮瓣翻转作衬里代替腹膜,作切口两侧皮瓣瓦合覆盖缝合修复缺损效果满意,报道如下.     

股外侧肌皮瓣修复腹部软组织缺损

1996年～ 1997年 ,我科应用带蒂股外侧肌皮瓣移位一期修复腹部软组织缺损 3例。术后随访 3～ 4年 ,治疗效果满意 ,报告如下。1　临床资料本组 3例 ,男 2例 ,女 1例。年龄 2 0～ 45岁 ,平均 31岁。1例以脐为中心的腹部恶性黑色素瘤患者 ,彻底切除瘤体后 ,腹壁及腹直肌缺损 13cm× 11cm,修复棘手 ,采用带血管蒂股外侧肌皮瓣移位修复腹直肌及皮肤缺损。经术后 4年随访 ,未出现腹疝 ,肠蠕动正常 ,肿瘤未复发及转移。 1例巨大腹壁疝切除疝囊后 ,腹直肌缺损 10 cm× 9cm ,取带蒂股外侧肌筋膜瓣移位修复疝环口软组织缺损。术后随访 3年 ,未见腹疝复…     

1例阔筋膜张肌转移肌皮瓣修复腹壁巨大组织缺损的护理

我院于2007年4月采用同侧阔筋膜张肌肌皮瓣转移覆盖关闭腹壁巨大缺损1例获得成功，现将护理报道如下。     

带蒂背阔肌皮瓣修复锁骨区恶性肿瘤切除术后皮肤软组织缺损

目的 探讨带蒂背阔肌皮瓣在修复锁骨区恶性肿瘤切除术后皮肤软组织巨大缺损的疗效.方法 对2015年11月-2018年1月收治的9例锁骨区恶性肿瘤患者,术前常规穿刺病检,病检结果证实后手术扩大切除,切除后所形成的巨大缺损创面采用带蒂背阔肌皮瓣进行修复.结果 术后经15～24个月随访,皮瓣全部成活,供区均一期愈合.近、远期随...     

应用瓦合式游离背阔肌肌皮瓣修复面中部肿瘤切除术后洞穿性缺损

目的：探讨应用瓦合式游离背阔肌肌皮瓣修复面中部皮肤恶性肿瘤切除术后洞穿性缺损的方法。方法：对下睑、内眦等面中部复发肿瘤进行扩大根治切除。对于切除肿瘤后形成的洞穿性缺损,应用瓦合式游离背阔肌肌皮瓣进行修复。结果：应用瓦合式游离背阔肌肌皮瓣修复面中部皮肤恶性肿瘤切除术后洞穿性缺损9例,肌皮瓣全部成活,外形良好。术后半年复查未见局部复发。3例患者于术后半年接受皮瓣去脂术。结论：应用瓦合式游离背阔肌肌皮瓣修复面中部皮肤恶性肿瘤切除术后洞穿性缺损成功率高,可达到功能和外形同时修复的效果。     

面颊部软组织缺损的显微修复

目的　报道应用皮瓣肌皮瓣修复面颊部软组织缺损的临床效果。　方法　应用显微外科技术施行吻合血管的游离皮 (肌 )瓣修复面颊部软组织缺损 3 6例 ,其中有背阔肌皮瓣 16例 ,阔筋膜张肌皮瓣 6例 ,髂腹股沟皮瓣 14例 ,皮瓣面积最大 6 0cm× 5 5cm。　结果　术后皮 (肌 )瓣全部成活 ,经随访结果外观及功能良好。　结论　应用显微技术修复面颊部软组织缺损不失为理想的方法。     

One-stage reconstruction of a massive abdominal wall defect with multiple flaps

Summary It is difficult to repair large abdominal wall defects. Thus, such defects have been managed by many methods. In this paper, a one-stage repair of an exceptionally large defect of the abdominal wall is described: this resulted from an en bloc excision of a recurrent squamous cell carcinoma. Multiple flaps — a rectus abdominis myocutaneous flap, tensor fascia lata flap and gluteal thigh flap — were successfully used to close the defect.Presented at annual regional meeting of Japan Society of Plastic Surgery, Tokyo, December, 1989     

Reconstruction of abdominal wall by whole thigh flap.

Closure of extensive abdominal wall defects can be a very challenging task as there are no known large local or free vascularized flaps available that could cover the entire abdomen. Tensor fascia latae (TFL) has been widely used for abdominal wall reconstruction [Hill HL, Nahai F, Vasocnez LO. The tensor fascia lata myocutaneous free flap. Plast Reconstr Surg 1978;61:517-22]. However, the dimensions of the standard TFL flap limit its use in cases of large full thickness abdominal wall defects. Therefore, we have used an ingenious technique of raising the entire thigh skin as a fasciocutaneous flap (whole thigh flap) based on the concept of fusion of angiosomal territories, to reconstruct such a defect following excision of a large abdominal wall tumour.     

Extended myofascial thigh flaps for repair of large full-thickness abdominal wall defects

The large, full-thickness abdominal wall defect encompassing the upper and lower quadrants can test the surgeon's ingenuity in providing definitive repair. Two cases are reported of this type of abdominal wall defect closed in one stage using an extended tensor fascia lata myofasciocutaneous flap and an extended rectus femoris myofascial flap, respectively. In addition, a fresh cadaver dye injection study demonstrates the extensive circulatory pattern of these flaps.     

Surgical treatment of abdominal wall tumor seeding after percutaneous transhepatic biliary drainage

Occasional cases of malignant seeding of cancer cells along the catheter tract, particularly affecting the skin, have been reported after percutaneous biliary drainage. Although radical resection of the abdominal wall may achieve long-term postoperative survival, reconstruction of large abdominal defects that cannot be closed primarily is problematic. We describe the successful surgical repair of a full-thickness defect of the abdominal wall using a free tensor fascia lata musculofasciocutaneous flap anastomosed to the intraabdominal gastroepiploic vessels.     

One-stage reconstruction of large midline abdominal wall defects using a composite free anterolateral thigh flap with vascularized fascia lata

OBJECTIVE: Large midline abdominal wall defects are continuously a challenge for reconstructive surgeons. Adequate skin coverage and fascia repair of the abdominal wall is necessary for achieving acceptable results. The purpose of this paper is to present a new approach to abdominal wall reconstruction using a free vascularized composite anterolateral thigh (ALT) flap with fascia lata. METHODS: Seven patients with large full-thickness abdominal wall defects were successfully reconstructed by means of a composite ALT flap combined with vascularized fascia lata. The size of the skin islands ranged from 20 to 32 cm in length and 10 to 22 cm in width, and the vascularized fascia lata sheath measured 14 to 28 cm and 8 to 18 cm, respectively. Functional outcome of the abdominal wall strength and donor thigh morbidity were investigated by using a Cybex kinetic dynamometer. RESULTS: All flaps survived. No postoperative ventral hernia occurred except for one mild inguinal incision hernia. Subjectively there were no significant donor site problems. Objective assessment was performed in 4 patients 2 years postoperatively. In the reconstructed abdomen, isokinetic concentric and eccentric measurements of extension/flexion ratios of the abdominal wall strength showed no apparent decrease compared with other references. Functional evaluation of quadriceps femoris muscle contraction forces after free ALT composite flap harvest showed an averaged deficit of 30% as compared with the contralateral legs. However, no difficulties in daily ambulating were reported by the patients. CONCLUSION: The free composite ALT myocutaneous flap with vascularized fascia lata provides an alternative option for a stable repair in complex abdominal wall defects.     

The versatility of tensor fascia lata allografts for soft tissue reconstruction

The purpose of this retrospective study was to introduce our successful use of tensor fascia lata allograft to reconstruct various soft tissue defects. Since May 2021, we have applied tensor fascia lata allografts in eight cases. A frozen type of fascia of 0.6 mm thickness was used in all cases, and allografts were covered by vascularized soft tissue. We used tensor fascia lata allograft in eight cases to cover the infected wounds, donor site closure, and pedicle protections. These were abdominal wall and back reconstructions following rectus muscle and latissimus dorsi muscle harvest, coverage of infected spine wound after posterior fusion, pressure ulcer reconstruction, and pedicle protection of free and pedicle flaps. The follow-up periods were from one to 14 months. None of the cases showed wound problems after initial reconstruction using tensor fascia lata allografts. Tensor fascia lata allograft could be an excellent cost-effective surgical option comparable to autologous tissue grafts. Level of evidence: IV.     

Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction

We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction.     

Incisional Hernia Repair in Renal Transplantation Patients

Introduction: Abdominal wall dehiscence in renal transplantation patients risks the survival of the transplanted organ. No clear treatment algorithm exists in the literature for this group of patients. Methods: Between 1992 and 2001, the Division of Plastic Surgery at the University of Maryland treated 41 of 2499 renal transplant patients. Based on a retrospective review of these patients, an algorithm was developed to guide the management of midline and lower quadrant abdominal wall defects. Results: Most lower quadrant defects were repaired with tensor fascia lata grafts. Most midline defects were repaired with the component separation technique. Use of a single- or multi-staged repair was based on the extent of infection. Hernia recurrence was 22% over 21 months. 80% of the transplant kidneys were functioning following repair. Conclusion: An algorithm for the repair of abdominal wall defects after kidney transplantation is presented taking into account the location and the extent of infection.     

Closure of chronic abdominal wall defects: a long-term evaluation of the components separation method

Incisional hernias and abdominal wall defects are frequently iatrogenic problems that have been found to complicate as many as 11% of all abdominal operations. Current techniques for closure of large, chronic abdominal wall defects have limitations. The use of local musculofascial flaps rather than fascial patches (i.e., the tensor fascia lata) or synthetic material for the repair of chronic abdominal wall defects is preferable. The superiority of innervated muscle flaps that provide dynamic abdominal support has been demonstrated. This report focuses on patients with chronic abdominal wall defects in whom previous techniques have failed. An algorithmic approach to planned reconstruction is presented utilizing the "components separation" technique as its foundation. Thirty-seven patients who underwent abdominal reconstruction following this algorithm are reviewed and their clinical course is outlined. The components separation technique provides a compound innervated and vascularized muscle flap for dynamic support of the reconstructed abdominal wall. The experience documented here and by others suggests that this technique is a safe and effective method for reconstructing the abdominal wall in patients with recurrent herniation. Enterocutaneous fistulas, however, continue to present a challenge to the surgeon.