小儿背阔肌皮瓣游离移植修复下肢严重损伤的远期疗效

目的 探讨小儿背阔肌皮瓣游离移植修复下肢严重损伤的可行性及远期疗效.方法 1999年7月-2004年6月,对9例6～13岁儿童下肢严重损伤,涉及小腿及足踝部大面积软组织缺损,伴复杂的开放性骨折与裸露的关节脱位、肌腱神经血管损伤,均采用背阔肌皮瓣游离移植修复,皮瓣面积最大30 cm×12 cm,最小10 cm×5 cm.结果 9例皮瓣全部成活,成功率100%;随访4～9年,移植皮瓣血运正常,外形及功能良好,皮瓣供区功能无明显影响.结论 背阔肌皮瓣解剖位置恒定,部位隐蔽,血运丰富,切取面积大,抗感染能力强,对供区影响小,在显微外科技术娴熟的条件下,是修复小儿下肢严重损伤的理想方法.

Long-term effect of free iatissimus dorsi muscle flap in repair of severe lower extremity injury in children

Objective To discuss the feasibility and long-term effect of free latissimus dorsi muscle flap in repair of severe lower extremity injury in children. Methods From July 1999 to June 2004, nine child patients (at age of 6-13 years) with severe lower extremity injury involving soft tissue defects a-round the calf and the foot associated with complex open fractures, bare dislocation, and injury of the nerve, tendon and artery were repaired with free latissimus donsi flap, with flap area ranging from 30 cm ×12 cm to 10 cm × 5 cm. Results All the latissimus dorsi flaps survived, with success rate of 100%. A follow-up for 4-9 years showed that the flap had sound shape and function and normal blood supply, without significant influence on donor area. Conclusion Latissimus dorsi flap has advantages of constant anatomical site, abundant blood supply, massive area, strong anti-infection ability and less in-fluence on donor area and hence is an ideal method for repairing severe lower extremity injury in children.