背阔肌皮瓣转移腋窝成形联合瘢痕松解术在腋部严重瘢痕挛缩畸形治疗中的应用

目的探讨背阔肌皮瓣局部转移腋窝成形术联合瘢痕松解修复烧灼伤后腋部严重瘢痕挛缩畸形的临床疗效。方法回顾性分析。2012年9月—2017年10月,青海红十字医院骨外科采用背阔肌皮瓣局部转移腋窝成形术修复9例腋部瘢痕挛缩畸形患者,其中男7例、女2例,年龄22~43岁。受伤原因:电击伤3例,烫伤4例,热压伤2例;腋部瘢痕挛缩畸形程度:轻度3例、中度5例、重度1例;受伤至整复时间为3~10年。患者均为上肢、前胸及腋部烧灼伤后导致瘢痕挛缩畸形,术前患者肩关节外展角度为47.5°±19.7°。术中先行瘢痕松解,松解后的皮肤缺损采用背阔肌皮瓣转移覆盖,切取皮瓣面积7 cm×12 cm^12 cm×20 cm,供区直接缝合或全/中厚皮片植皮覆盖。结果本组9例患者术后随访9~26个月,平均18个月。术后皮瓣均成活,1例皮瓣边缘部分坏死,经换药后治愈;6例供区直接缝合,3例部分缝合后小面积缺损采用全/中厚皮片移植覆盖,植皮均成活,所有病例供区均无感染、皮肤坏死等并发症发生。术后6个月随访,皮瓣质地柔软,外观佳,肩关节活动明显改善,外展角度达127.8°±23.5°,与术前相比差异有统计学意义(t=7.860,P<0.01)。结论背阔肌皮瓣血运丰富,抗感染能力强,术后皮瓣成活率高,外观佳,肩关节功能恢复好,临床效果满意。

Pedicled latissimus dorsi flap transfer and axillary plasty combined with cicatricial loosening for treatment of severe postburn axillary scar contracture

Objective To investigate the clinical effect of latissimus dorsi flap local axillary augmentation combined with scar release to repair severe scar contracture deformity after burn injury.Methods From September 2012 to October 2017, 9 cases of axillary scar contracture repaired by latissimus dorsi flap in Department of Orthopedics, Qinghai Red Cross Hospital were retrospecively analyzed, including 7 males and 2 females, aged 22-43 years old. The cause of injury were 3 cases in electric injury, 4 cases in scald and 2 cases in hot press. According to the classification of scar contracture deformity in axilla, 3 cases were mild, 5 cases were moderate, and 1 case was severe. The time from injury to rehabilitation were 3-10 years. The cicatricial contracture developed after burn injury on the upper limb, the anterior chest and the axilla. The abduction angle of the shoulder was 47.5°±19.7°. The scar was first loosened.The skin defect was covered by partial transfer of latissimus dorsi flap.The area of the flap was 7 cm×12 cm to 12 cm×20 cm. The donor area was direct suture or full/medium thick skin grafting.Results All cases were followed up for 9 to 26 months(average of 18 months). The skin flap survived after operation, 1 case of the skin flap was necrotic and cured after dressing change. 5 cases were directly sutured in the donor area. 4 cases were transplanted with full/medium thick skin grafts, and the skin grafts survived. All cases were free of infection and skin necrosis. At 6 months of follow-up, the skin flaps were soft, the appearance was good and the shoulder joint activity was obviously improved. The average abduction angle was 127.8°±23.5 °. The difference was statistically significant compared to those before operation. (t=7.860, P<0.01) .Conclusions The blood transportation of latissimus dorsi flap is rich,with strong anti infection ability,high survival rate and good appearance.Recovery of shoulder joint function is good,and the clinical effect is satisfactory.