应用背阔肌肌皮瓣重建上肢功能及修复复合组织缺损

目的探讨背阔肌肌皮瓣重建上肢肌肉功能、修复上肢软组织缺损创面的临床效果。方法2008年7月～2014年12月新疆医科大学第一附属医院骨科中心采用背阔肌肌皮瓣移植修复34例上肢肌肉功能、软组织缺损创面,男性25例,女性9例;年龄17～65岁,平均40.5岁。其中屈肘功能障碍者10例,屈肘并屈指功能障碍者7例,伸肘伸指功能障碍者5例,肘部皮肤缺损或骨外露12例。背阔肌肌皮瓣大小范围11cm×4cm～35cm×10cm;供区大部分采取一期缝合,2例供区部分缝合、部分采用中厚皮片植皮。结果34例患者术后获随访8个月～7年,平均21个月。其中术后出现血管危象2例,对症处理后好转;肌皮瓣的皮瓣部分坏死2例;背阔肌肌皮瓣完全坏死2例,发生局部感染1例,经清创换药完全愈合;其余18例未见明显术后并发症。结论背阔肌皮瓣血运丰富,抗感染能力强,肌瓣可填塞死腔,背阔肌肌皮瓣是修复上肢肌肉功能、上肢软组织缺损创面和骨外露感染创面的一种理想皮瓣。

Clinical application of Latissimus dorsi muscle flap to repair and reconstruct dysfunction and complex soft tissue defects of upper extremities

Objective To investigate the clinical effect of latissimus dorsi myocutaneous flap for reconstruction of upper limb muscle function and repairing of upper limb soft tissue defect. Methods From Jul.2008 to Dec.2014,latissimus dorsi myocutaneous flap was used to repair 34 cases of upper limb muscle function and soft tissue defect.There were 25 males and 9 females,aged from 17 to 65 years (mean,40.5years).Ten cases had elbow flexion dysfunction,7 cases had elbow flexion and finger flexion dysfunction,5 cases had elbow extensor dysfunction,and 12 cases had elbow skin defect and bone exposure.Latissimus dorsi myocutaneous flap size ranged from 11cm× 4cm-35cm×10cm.Most of the donor sites were treated with primary suture,and 2 cases were treated with partial thickness skin graft. Results All 34 patients were followed up for a period of 8 months to 7 years (average,21 months).Two cases of vascular crisis after operation were improved after symptomatic treatment;skin flap necrosis developed in 2 cases;2 cases had latissimus dorsi musculocutaneous flap necrosis completely;2 cases developed infection and were cured by debridement and dressing change.The other 18 cases had no obvious complication. Conclusion The latissimus dorsi flap has abundant blood supply and strong anti-infection ability.Muscle flap can fill dead space.The latissimus dorsi myocutaneous flap is an ideal flap for repairing upper limb muscle function,soft tissue defects and bone exposure with infection.