保留皮肤的乳癌改良根治术后即时背阔肌肌皮瓣乳房再造

目的介绍保留皮肤的乳癌改良根治术后即时背阔肌肌皮瓣乳房再造的经验。方法对Ⅰ,Ⅱ期乳腺癌行保留乳房皮肤经皮下切除乳腺组织,清扫腋窝淋巴结,应用背阔肌肌皮瓣即时乳房再造。结果应用该方法治疗3 7例,经随访7 5个月,再造乳房自然柔软,外观形态良好,满意率94.6%。结论保留皮肤的乳腺癌根治术后即时背阔肌肌皮瓣乳房再造具有操作方便,治疗效果良好,患者满意度高,是值得推广的好方法。     

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.     

带蒂背阔肌肌皮瓣移植修复严重左上肢电击伤

我们收治1例左掌腕部、前臂中下段、肘窝被1万伏高压电接触烧伤,采用带蒂的巨大背阔肌肌皮瓣移植修复,保存了肢体及部分功能,报道如下。 病例介绍及手术方法 患者,男、28岁。左上肢被1万伏高压电烧伤,伤后10天入院。检查:左手掌腕     

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。     

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,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 应用该方法再造乳房95例,其中保留乳头乳晕改良根治术后即时再造24例,保留皮肤改良根治术后即时再造36例,改良根治术后即时再造26例,后期再造9例,其中1例为改良根治术后,其他8例为改良根治术后,再造乳房均形态良好.术后6例乳头部分坏死;14例胸部皮肤表皮脱落,自行愈合;2例背部供区部分坏死;背部顽固性血清肿2例,再次手术后愈合.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,尤其适用于中、小乳房的乳房再造.     

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.     

Intraoral reconstruction with latissimus dorsi myocutaneous island flap

Summary Intraoral reconstruction for large defects using a latissimus dorsi myocutaneous island flap in ten patients is presented. All flaps were transferred successfully in one stage and provided adequate flap tissue for the intraoral defect. Five cases involved hemiglossectomy. The postoperative atrophy of the flap was minor and the intraoral defects were adequately resurfaced. The postoperative function of the remaining tongue was satisfactory. The latissimus dorsai myocutaneous flap was found to be reliable and useful for intraoral reconstruction.     

背阔肌游离肌皮瓣用于颅颌面部缺损重建

目的　提高颅颌面部组织缺损的修复水平。方法　本组 8例颅颌面部组织缺损患者 ,皮肤和黏膜缺损面积最小 10cm× 8cm ,最大 30cm× 12cm ,应用背阔肌游离肌皮瓣移植修复 ,所有皮瓣的神经均与受区神经吻合。 7例患者一期手术完成 ,另 1例分 3次手术完成 :第 1次行皮瓣延迟 ,第 2次手术行游离皮瓣移植 ,第 3次手术行口角成形术。肌皮瓣面积最小 12cm× 10cm ,最大 32cm× 16cm。结果　术后随访 6个月～ 4年 ,所有患者功能和形态满意 ,感觉恢复良好 ,无皮瓣发生坏死和溃疡。结论　背阔肌游离肌皮瓣移植是一种修复严重颅颌面部组织缺损的较为理想的方法 ,具有血供可靠、抗感染力强、供瓣面积大、供区隐蔽、可重建运动和感觉功能等优点。     

背阔肌肌皮瓣移植修复严重深度烧伤

目的总结高压电烧伤、热压伤创面适用背阔肌肌皮瓣进行修复的经验。方法26例严重深度烧伤创面,应用背阔肌肌皮瓣移植,其中岛状转位25例,游离移植1例。对上肢广泛电击伤及热压伤创面采用该肌皮瓣与侧胸皮瓣及髂腰部皮瓣联合移植修复,全跟腱坏死应用游离背阔肌肌皮瓣修复。结果皮瓣面积最大40cm×20cm,除1例皮瓣尖端坏死2cm,其余全部成活。跟腱的功能恢复满意。结论背阔肌肌皮瓣修复严重深度烧伤是一种理想的方法。     

Double island latissimus dorsi myocutaneous flap in the treatment of high-voltage electrical injuries of the upper extremity

Summary In the treatment of high-voltage electrical injuries of the upper extremity, one-stage procedures are superior to multiple-stage procedures since time is a critical factor in obtaining functional results. In two cases of high-voltage electrical injuries of the upper extremity, a latissimus dorsi flap with double skin islands was used as a one-stage procedure to cover two separate defects in the axillary and cubital regions, and to restore the elbow flexion. The procedure is described and the alternative methods of treatment of high-voltage electrical injuries of the upper extremity are discussed.     

Reconstruction after radical hemimaxillectomy using a free multidimensional latissimus dorsi myocutaneous flap

Summary A series of safe, simple and single-staged reconstructions following radical resection of maxillary antral carcinomas with soft tissue involvement is presented. These reconstructions were performed using free triple-folded latissimus dorsi myocutaneous flaps revascularised via the facial vessels. This technique can be safely used in irradiated patients and, when indicated, allows for the administration of early postoperative radiotherapy, thus improving the potential cure rate. Advantages and disadvantages of the technique are discussed.     

Free transfer of latissimus dorsi myocutaneous flap using wrist vessels as carriers for the treatment of Lumbo-Sacral Scar Contracture Deformity

Summary After excision of extensive post infection back scarring, there were no local flaps and no satisfactory recipient vessels for closure of the defect. A latissimus dorsi free flap was carried on the radial artery and cephalic vein and used to effect the reconstruction. The pedicle was divided at four weeks. The back deformity was corrected completely. By means of microsurgical techniques, free transfer of the latissimus dorsi myocutaneous flap is commonly used to repair a large soft tissue defect following excision of scar contracture deformity [1]. This was a problem in one of our cases where no vessels were available for anastomosis in the recipient site, and thus wrist vessels were used as carriers to revascularize the flap with success.     

背阔肌肌皮瓣移位重建晚期臂丛神经上千损伤屈肘功能的疗效评价

目的 评价背阔肌肌皮瓣移位重建晚期臂丛神经上干损伤屈肘功能的疗效.方法 自2008-01-2013-12采用背阔肌肌皮瓣单极移位法重建9例晚期臂丛神经上千损伤屈肘功能,其中5例将背阔肌远端分别固定于肱桡肌及肱二头肌腱和4例采用传统方法.结果 背阔肌肌皮瓣全部存活,伤口愈合良好,无感染等并发症发生.9例获得随访12～36个月,平均28个月.7例术后肌力恢复到M4,2例肌力恢复到M3,屈肘角度50°～110°,平均91°.患者术前、术后肌力比较,差异有统计学意义(t =9.34,P＜0.05).根据远端固定2种方式,采用多元T统计分析2组肌力、屈肘力量、角度恢复程度,两者差异无统计学意义(F =1.18,P＞0.05).结论 采用背阔肌肌皮瓣移位重建晚期臂丛神经上千损伤届肘功能的疗效满意.     

应用背阔肌岛状肌皮瓣修复烧伤后乳房畸形

目的 介绍应用背阔肌岛状肌皮瓣修复前胸壁烧伤后所致乳房瘢痕挛缩畸形的临床效果.方法 应用扩张或未扩张的背阔肌岛状肌皮瓣修复烧伤后乳房瘢痕、部分缺损畸形,其中轻、中度烧伤后乳房缺失2例,采用背阔肌岛状肌皮瓣修复重度乳房缺失5例,采用扩张的背阔肌岛状肌皮瓣修复.结果 共治疗7例,术后肌皮瓣完全成活,乳房形态明显改善,无肌皮瓣坏死、背部伤口感染、裂开及肩部功能障碍等并发症发生.供区无明显后遗畸形及功能障碍.结论 背阔肌岛状肌皮瓣血运良好,操作简便易行,是修复烧伤乳房畸形的较好方法.     

腹直肌-背阔肌肌皮瓣联合应用乳房再造术

目的　探索一种同时修复乳房和胸壁缺损的手术方法。方法　利用下腹部横行腹直肌肌皮瓣 (下简称TRAM皮瓣 )和部分背阔肌肌皮瓣 ,为乳癌术后患者行乳房再造及胸壁缺损修复。结果　 4例 8个皮瓣全部成活 ,再造乳房及胸壁缺损修复效果满意。结论　联合应用腹直肌—背阔肌肌皮瓣 ,可以同时完成乳房再造及胸壁缺损的修复 ,效果满意。