腹直肌肌皮瓣修复胸壁放射性溃疡

腹直肌肌皮瓣修复胸壁放射性溃疡谢舒，李素芝放射性溃疡因其病理生理、组织学特点，治疗较为棘手。我们采用腹直肌肌皮瓣移泣修复２例因Ⅲ期乳腺癌行乳癌根治术后，放射治疗致胸壁溃疡。溃疡发生时间距最后一次照射１例５年，１例７年。面积分别为１０×１４ｃｍ和６×２...     

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。     

腹直肌肌皮瓣在胸部缺损修复中的应用

目的:探讨腹直肌肌皮瓣在胸部缺损修复中的应用效果。方法:选取笔者科室2015年5月-2018年12月的8例患者,乳腺癌术后乳房缺损2例,放射性溃疡合并乳房缺损3例,胸骨骨髓炎患者3例。其中5例采用纵行腹直肌肌皮瓣;3例采用横行腹直肌肌皮瓣修复,供瓣区给予缝合修复。结果:8例患者腹直肌肌皮瓣均成活良好,创面痊愈,其中5例乳房重建患者效果满意。术后随访1～3年,溃疡无复发,供瓣区无腹壁疝形成。结论:腹直肌肌皮瓣血运可靠、组织量充足,是修复胸壁溃疡及女性乳房重建的理想选择,是一种有效、简单和安全的方法。     

半腱肌肌瓣加阔筋膜张肌肌皮瓣修复坐骨结节褥疮

半腱肌肌瓣加阔筋膜张肌肌皮瓣修复坐骨结节褥疮郭力＊丁尔英＊谢兴乾＊廖毅＊我们采用半腱肌肌皮瓣加阔筋膜张肌肌皮瓣修复坐骨结节褥疮１０例，术后全部成功。疗效满意。１临床资料本组均为男性，因外伤致截瘫，年龄２０岁～３８岁，平均２５．１岁，病程２个月～９年。...     

应用肌皮瓣修复前胸壁放射性溃疡

目的总结前胸壁慢性放射性溃疡的临床治疗效果。方法应用肌皮瓣修复前胸壁慢性放射性溃疡22例，手术扩创后用背阔肌肌皮瓣修复15例，胸大肌肌皮瓣修复2例，腹直肌肌皮瓣修复5例。结果移植肌皮瓣全部成活痊愈。溃疡甲级愈合19例、乙级愈合3例。术后随访6个月-3年溃疡无复发，供区无异常。结论应用带血运的肌皮瓣转移修复创面解决了前胸壁区因根治手术或放射所致的血管损伤而引起的创面难愈合问题，能有效改善血液循环，促进创面愈合。     

带蒂腹直肌肌皮瓣修复胸壁深度放射性溃疡

目的探讨胸壁深度放射性溃疡清创后应用带蒂腹直肌肌皮瓣修复的临床效果。方法 2012年1月至2018年12月,共收治5例胸壁深度放射性溃疡患者,创面给予手术清创后,应用带蒂腹直肌肌皮瓣进行修复。结果移植皮瓣全部成活,溃疡愈合良好。术后随访0.5~1年,胸壁溃疡无复发。结论胸壁深度放射性溃疡经有效外科清创后,采用血管恒定、血供丰富、组织量大的带蒂腹直肌肌皮瓣进行修复,是临床较好的选择。     

应用肌皮瓣修复乳腺癌术后胸壁放射性溃疡创面

目的 探讨应用肌皮瓣修复乳腺癌术后胸壁放射性溃疡的临床治疗效果. 方法 2009年1月-2011年1月,对乳腺癌术后胸壁放射性溃疡患者18例,手术扩创后应用肌皮瓣修复,其中采用背阔肌肌皮瓣修复12例,腹直肌肌皮瓣6例对于溃疡较深,累及胸膜或并发放射性骨髓炎的5例,先采用Prolene网或Marlex网修复骨性胸壁缺损,再用肌皮瓣覆盖缝合创面. 结果 18例肌皮瓣全部成活,1例腹直肌皮瓣修复术后第4天局部边缘有渗液,经拆线引流、换药后痊愈,其余17例患者伤口愈合良好.随访6～12个月,无溃疡复发,无皮瓣坏死、皮瓣感染以及皮下积液. 结论 应用血运良好的肌皮瓣可有效修复乳腺癌术后胸壁的放射性溃疡创面.     

应用肌皮瓣联合持续负压封闭引流技术修复慢性皮肤放射性溃疡

目的:探讨应用肌皮瓣联合持续负压封闭引流(Vacuum Sealing Drainage,VSD)技术修复慢性皮肤放射性溃疡的临床效果。方法:自2012年5月至2014年5月郑州大学第一附属医院整形外科采用肌皮瓣联合VSD技术修复慢性皮肤放射性损伤6例,臀大肌肌皮瓣3例,胸大肌肌皮瓣2例,腹直肌肌皮瓣1例。结果:采用肌皮瓣联合VSD术,6例患者移植皮瓣均成活、愈合。术后随访6月~3年,无溃疡复发或形成新的溃疡。结论:肌皮瓣血供丰富,组织量大,充填效果及外观良好,围手术期联合VSD技术清洁创面,促进肉芽生长,同时清除创面内渗液及液化组织,是修复严重放射性溃疡和功能重建行之有效的方法。     

应用腹直肌皮瓣修复乳癌放疗后放射性溃疡

目的：探讨腹直肌肌皮瓣在乳癌放射性治疗（以下简称放疗）后放射性溃疡修复中的应用。方法：2007年以来应用健侧单蒂腹直肌肌皮瓣转移修复乳癌放疗后放射性溃疡16例。9例采用纵行腹直肌肌皮瓣,其中3例合并臂丛神经损伤的患者为其行臂丛神经松解术并局部注射间充质干细胞;7例采用横行腹直肌肌皮瓣修复,其中4例同时行乳房再造术。结果：1例患者皮瓣远端部分坏死,清创术后采用局部皮瓣修复;2例术后出现皮瓣下渗出积液,手术予以再次清创。其余皮瓣成活良好,创面修复满意。结论：腹直肌肌皮瓣血运可靠,是修复乳癌放疗后放射性溃疡的一种较为有效、简单和安全的方法,应根据具体的病变程度、范围设计适宜的肌皮瓣转移方式。     

多种皮瓣修复乳腺癌术后放疗继发前胸壁放射性溃疡的临床评价

目的 总结多种皮瓣修复乳腺癌术后放疔继发前胸壁放射性溃疡的疗效和经验.方法 自2000年1月至2008年12月,共收治乳腺癌术后放疗继发前胸肇放射性溃疡患者24例.采用下腹部横行腹直肌肌皮瓣(11例)、背阔肌肌皮瓣带蒂转移术(9例)和健侧乳房皮瓣(4例)转移修复溃疡.肌皮瓣面积为18 cm×12 cm～36 cm ×9 cm,乳房皮瓣面积为13 cm ×6 cm～16 cm×6 cm.2例患者在行背阔肌肌皮瓣转移术前行DSA检查,明确胸背动脉的位置.背阔肌肌皮瓣供区行中厚皮片移植修复,其余供瓣区直接拉拢缝合.结果 1例因下腹腹直肌肌皮瓣巨大、脂肪过于肥厚而出现尖端皮肤干性坏死和脂肪液化,其余23例皮瓣均完全成活.术后随访3～12个月,溃疡无复发.结论 背阔肌肌皮瓣是修复前胸壁放射性溃疡的首选皮瓣.术前行DSA检杳明确胸背动脉的位置,是保证手术成功的有效方法.带蒂下腹腹直肌肌皮瓣因手术难度和创伤较大,可作为次选.健侧乳房皮瓣可导致健侧乳房畸形,且供瓣区面积有限,因而尽可能避免选用.     

修复严重放射性溃疡的临床研究

【摘要】〓目的〓使用皮瓣或肌皮瓣对严重放射性溃疡进行修复的临床经验。方法〓对我科在2010年1月至2012年1月,采用各种皮瓣或肌皮瓣方法修复治疗的22例放射溃疡患者病例进行回顾性分析,其中使用背阔肌皮瓣4例,侧腹壁皮瓣3例,脐旁皮瓣3例,股前外侧皮瓣4例,胸大肌皮瓣6例,臀大肌皮瓣2例。 结果〓22例患者中有2例出现了皮瓣远端局部坏死,经换药治疗后创面闭合。其他20例皮瓣全部成活,伤口一期愈合。经1~2年随访,15例患者皮瓣外观良好,质地柔软,临床溃疡无复发。结论〓临床采用皮瓣或者肌皮瓣治疗严重放射性溃疡,能够获得良好治疗效果,并能有效预防溃疡复发,值得推广。     

游离腹直肌瓣加中厚植皮修复四肢骨及肌腱外露

目的：观察应用游离腹直肌瓣加中厚游离植皮修复四肢骨,肌腱外露的疗效。方法：应用游离腹直肌瓣加中厚游离植皮修复前臂桡骨,肌腱外露1例,股骨外露2例,足部骨骼外露5例。结果;腹直肌瓣均全部成活,2例植皮坏死,经再次植皮愈合,外形及功能尚满意。结论：游离腹直肌瓣血管蒂长,口径粗,解剖恒定,操作简便,损伤小,无形成腹壁疝的缺点,游离腹直肌瓣加中厚游离植皮具有抗感染力强,顺应性好,无肥厚且外形好的优点。     

Versatile use of rectus abdominis muscle and musculocutaneous flaps for soft-tissue reconstruction: our clinical experiences in 25 cases

The rectus abdominis muscle and musculocutaneous flaps have contributed to the efficient reconstruction of tissue defects that require a large amount of cutaneous and muscular tissue. In this article, outcomes of soft-tissue defects after reconstruction with the rectus abdominis muscle and musculocutaneous flaps were retrospectively analyzed. From August 2003 to June 2009, 25 flaps were transferred to reconstruct a wide variety of soft-tissue defects in the breast, chest wall, groin, perineal, and head and neck regions, as well as the upper and lower extremities. The rectus abdominis muscle and musculocutaneous flaps were used as part of 11 different approaches in 25 cases. There were 13 male and 12 female patients; the mean patient age was 44.2 years. The mean follow-up period was 8 months (range, 4–15 months). The overall success rate was 100%, and all flaps healed uneventfully. All reconstructive procedures were completed without any major complications. Rectus sheets were repaired primarily, and no mesh application was used. Minor complications related to transferred flaps were wound infection and dehiscence in one case, wound dehiscence in two cases, and flap lymphedema in one case. Minor complications related to the donor site were seroma in one case and wound infection and dehiscence in another case. This study presents our experience with the rectus abdominis muscle and musculocutaneous flaps in a series of 25 cases. The indications for the use of this particular flap with other flaps are discussed.     

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     

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.     

应用带少许肌袖的背阔肌肌皮瓣修复下肢软组织缺损

目的探讨应用带少许肌袖的背阔肌肌皮瓣移植修复下肢软组织缺损的临床效果。方法2000年6月～2006年12月,应用带少许肌袖的背阔肌肌皮瓣移植修复8例下肢软组织缺损患者。男6例,女2例;年龄25～69岁。其中创面位于足跟3例,足背2例,胫前2例,右小腿鳞癌1例。软组织缺损范围10cm×7cm～18cm×12cm,皮瓣切取范围15cm×8cm～22cm×15cm。结果术后6例皮瓣成活;1例术后2h出现皮瓣血管危象,经探查重新吻合静脉,植皮后成活;1例胫前创面因骨髓炎感染,经引流后皮瓣成活。创面及供区均期愈合。8例患者获随访3～12个月。皮瓣外形满意,无臃肿。供区功能不受影响。结论应用带少许肌袖的背阔肌肌皮瓣移植是修复大面积肢体软组织缺损较为理想方法之一。     

游离股前外侧皮瓣与筋膜瓣修复手足部软组织缺损

目的比较股前外侧皮瓣与筋膜瓣修复手足部软组织缺损的疗效。方法15例手足软组织缺损分别采用游离股前外侧皮瓣或筋膜瓣修复。结果随访4～15个月,所有患者组织瓣均成活,其中1例曾发生血管危象,经减张、解痉后血供恢复。用皮瓣修复的病例在外观及功能上不如筋膜瓣满意。结论游离股前外侧筋膜瓣是修复手足部大面积软组织缺损的理想方法。     

Reconstruction of full-thickness chest wall defects using rectus abdominis musculocutaneous flap: a report of fifteen cases

In 15 patients chest walls were excised because of recurrent breast cancer, radiation ulcer, or rib tumor. In most cases the full-thickness defect of the chest wall was about 10 x 10 cm. Reconstruction was performed using only a rectus abdominis musculocutaneous flap. No patient developed circulation problems in the flap or severe flail chest, and we had successful results in all our cases. These results show that the rectus abdominis musculocutaneous flap is quite effective and safe to use in the reconstruction of chest wall defects.     

应用中下腹横形腹直肌皮瓣修复胸壁慢性放射性溃疡

目的 探讨乳癌根治术后胸部慢性放射性溃疡的特点及防治特点.方法 对胸部放射溃疡并肋骨、肋软骨或胸骨外露的患者,采用中下腹部横形腹直肌肌皮瓣(TRAM)修复12例,其中单腹直肌蒂6例,单腹直肌蒂附加血管吻合双蒂皮瓣6例.结果 皮瓣全部成活,皮瓣和创缘均一期愈合.随访1～4年,皮瓣色泽、质地、弹性良好.周边瘢痕性组织血运得以改善.结论 TRAM皮瓣是修复胸壁放射性溃疡的理想选择,必要时可附加血管吻合形成双蒂皮瓣.