CAJ | 학술논문

背景:尽管胸背动脉穿支皮瓣能减轻供区损伤和避免受区臃肿,但是由于分离穿支相当费时,有人认为仅限于经验丰富医生并主张保留部分肌肉组织.目的:探讨应用穿支皮瓣理念设计的背阔肌皮瓣游离移植修复下肢的移植方案及其修复效果.方法:纳入17例需要皮瓣移植的患者,12例背阔肌肌(皮)瓣,3例保留部分肌袖的背阔肌瓣和2例分叶背阔肌组织瓣均采用穿支皮瓣理念设计,根据胸背动脉的供血范围,皮瓣靠前设计,以供区能直接拉拢缝合为度,切取时将胸背动脉外侧支的皮穿支包含在内.必要时可再向内侧切除背阔肌肌瓣以扩大移植组织块面积,有时为了修复两个相邻部位的缺损,可切取保留部分肌袖的背阔肌瓣和以胸背动脉外侧支营养的部分背阔肌肌瓣并形成分叶背阔肌组织瓣.组织瓣切取范围12 cm×8 cm～28 cm×17 cm.观察患者皮瓣移植后成活情况、皮瓣供区和受区的外形及功能.结果与结论:皮瓣移植后1例血管危象发生,探查重新吻合血管后危象解除,所有皮瓣均成活;1例肌瓣植皮部分坏死,二期植皮修复;供区创面均直接拉拢缝合.15例患者随访3～18个月,其中2例皮瓣外形臃肿,影响穿鞋,二期行皮瓣修薄术.提示应用穿支皮瓣理念设计背阔肌瓣能有效减轻供区损伤和受区臃肿畸形,分叶背阔肌组织瓣能较好修复足底和足尖两处软组织缺损,结合穿支皮瓣理念、个性化设计不同形式的背阔肌瓣可满意修复较大下肢皮肤软组织缺损.
배경:진관흉배동맥천지피판능감경공구손상화피면수구옹종,단시유우분리천지상당비시,유인인위부한우경험봉부의생병주장보류부분기육조직.목적:탐토응용천지피판이념설계적배활기피판유리이식수복하지적이식방안급기수복효과.방법:납입17례수요피판이식적환자,12례배활기기(피)판,3례보류부분기수적배활기판화2례분협배활기조직판균채용천지피판이념설계,근거흉배동맥적공혈범위,피판고전설계,이공구능직접랍롱봉합위도,절취시장흉배동맥외측지적피천지포함재내.필요시가재향내측절제배활기기판이확대이식조직괴면적,유시위료수복량개상린부위적결손,가절취보류부분기수적배활기판화이흉배동맥외측지영양적부분배활기기판병형성분협배활기조직판.조직판절취범위12 cm×8 cm～28 cm×17 cm.관찰환자피판이식후성활정황、피판공구화수구적외형급공능.결과여결론:피판이식후1례혈관위상발생,탐사중신문합혈관후위상해제,소유피판균성활;1례기판식피부분배사,이기식피수복;공구창면균직접랍롱봉합.15례환자수방3～18개월,기중2례피판외형옹종,영향천혜,이기행피판수박술.제시응용천지피판이념설계배활기판능유효감경공구손상화수구옹종기형,분협배활기조직판능교호수복족저화족첨량처연조직결손,결합천지피판이념、개성화설계불동형식적배활기판가만의수복교대하지피부연조직결손.
BACKGROUND: Thoracodorsal artery perforator flap can relieve damage to donor site and avoid bulk in the recipient site,but dissociation of perforating branch took time.Some one believed that it should be done by very experienced physicians and some muscle tissues should be reserved.OBJECTIVE: To investigate the method,effectiveness and clinical application of improved latissimus dorsi flap based on perforator flap conception for reconstruction of soft tissue defects of lower extremity.METHODS: A total of 17 patients needing skin flap transplantation were selected.12 latissimus dorsi musculocutaneous/muscle flaps,3 latissimus dorsi flaps with a few muscle and 2 double-leaf segmental latissimus dorsi compound flaps were designed based on perforator flap conception.According to the territory of latissimus dorsi musculocutaneous flap,a skin paddle in which anterior underlying muscle and main perforator was designed,extend about to the anterior edge of the latissimus dorsi muscle.An additional latissimus dorsi muscle flap was selected for soft tissue enlargement if necessary.Sometimes,double-leaf segmental latissimus dorsi musculocutaneous/muscle flap,including one muscle-sparing latissimus dorsi musculocutaneous flap and the other segmental latissimus dorsi muscle flap nourished by the lateral branches of the thoracodorsal vessels was selected to repair two adjacent defects.The harvested tissue area ranged from 12 cm×8 cm to 28 cm×17 cm.Survival state of skin flap,together with shape and function of donor site and recipient site of skin flap were observed.RESULTS AND CONCLUSION: Following skin flap transplantation,one case developed vascular crisis that was relieved following re-exploration for vessel anastomosis.All skin flap survived.Second-stage skin grafting was done on one muscle flap wound.All donor sites were sutured directly.After a follow-up of 3 to 18 months in 15 cases,only two cases received two-stage plastic operation because bulky flaps brought some trouble in wearing shoes.Improved latissimus dorsi flap based on perforator flap conception can reduce damage to the donor site and the receipt area bulk.Double-leaf segmental latissimus dorsi compound flaps can repair both heel and toe wound.The versatile latissimus dorsi flap designed using thoracodorsal artery perforator flap conception is an ideal flap for repairing widespread soft tissue defects in the lower extremity.