桥式交叉"T"形血管吻合游离背阔肌皮瓣移植修复小腿软组织缺损

目的 介绍改进桥式交叉游离皮瓣移植的手术方法并总结分析.方法 2003年9月至2007年5月,应用桥式交叉"T"形血管吻合游离背阔肌皮瓣移植方法修复小腿软组织缺损患者6例.男5例,女1例;年龄21～48岁(平均32岁).软组织缺损范围20 cm×9 cm～32 cm×11 cm.皮瓣血管蒂切取时携带肩胛下与旋肩胛血管,使蒂呈"T"形,将其与健侧小腿胫后动脉两断端行端端吻合,血管蒂行中厚网状游离植皮包裹,未用皮管,小腿供区切口直接缝合.结果 1例术后皮瓣远端发生小的表浅感染,换药2周后愈合,皮瓣全部成活,术后经过顺利,获得较满意的效果.随访6个月～4年(平均2.7年),未发现明显的供区功能障碍.供区与皮瓣外形较好,供区小腿经临床观察与多普勒检查证实胫后动脉通畅.结论 利用"T"形血管与胫后血管吻合,降低对侧小腿供区的损伤,只要血管吻合质量好,对皮瓣血供无影响.这种技术特别适用于小腿软组织缺损须行血管吻合的皮瓣修复、但肢体仅有一根主要血管的病例.

Application of T-shaped cross-bridge vascular anastomosis free latissmus dorsi musculocutaneous flap transplantation in repairing of soft tissue defect in the lower extremity

Objective To introduce the improved surgical technique of the cross-bridge vascular anastomosis free flap transplantation for tissue defects of extremities.Methers From September 2003 to May 2007, 6 patients with soft tissue defects of the lower extremities underwent tissue reconstruction with the T-shaped cross-bridge vascular anastomosis free latissmus dorsi musculocutaneous flap transplantation.There were 5 males and 1 female with an average age of 32 years(range, 21-48 years).Soft tissue defects in the lower extremities ranged from 20 cm×9 cm to 32 cm×11 cm.The flaps were elevated with the subscapu1ar and circumflex scapular vessels forming a T-shaped pedicle.The vascular pedicle of flaps, which were harvested into T-shaped were anastomosed to the both ends of the posterior tibial artery of the other leg by end-to-end anastomosis.The vascular pedicle was wrapped by a meshed split-thickness free skin graft.The wound of the donor site was sutured directly.Results The follow-up time was 6 months to 4 years with an average of 2.8 years.All flaps had survived completely with satisfactory clinical results.One case developed distal tip skin infection and cured by debridement.There were no remarkable donor site complications.All cases had good appearance in recipient and donor sites.The patency of the posterior tibial artery of the donor extremities were demonstrated by Doppler examination.Conclusion The technique that the T-shaped vascular pedicle was anastomosed to the posterior tibial artery of contralateral leg reduced iniury of donor site.As long as the quality of the vascular anastomosis is satisfactory,the blood supply of the flap is guaranteed.This technique is particularly useful when only one vessel iS available in the donor extremity.