CAJ | 학술논문

目的探讨胸背动脉穿支皮瓣游离移植和带蒂转移修复四肢及颈部、腋窝、肩背部皮肤软组织缺损的可行性和临床效果.方法选用同侧带血管蒂胸背动脉穿支皮瓣修复5例颈部、腋窝、肩背部创面；选用胸背动脉穿支皮瓣游离移植修复11例四肢骨外露或肌腱外露创面.其中12例以胸背动静脉-外侧支-穿支为血管蒂,4例以胸背动静脉-前锯肌支-穿支为血管蒂,皮瓣不携带深筋膜、背阔肌和胸背神经.皮瓣面积最小10 cm×5 cm,最大26 cm×10 cm.结果术后16例皮瓣全部成活,供区与受区创面一期愈合.术后随访3～ 24个月,皮瓣质地良好、外形不臃肿,皮瓣供区瘢痕不明显,肩关节功能无影响.结论胸背动脉穿支皮瓣质地良好、供区隐蔽、血管蒂长、血供可靠,且不牺牲背阔肌和胸背神经.带蒂转移是修复同侧颈、肩、腋窝皮肤软组织缺损的理想方法,游离移植适合修复四肢皮肤软组织缺损.
목적 탐토흉배동맥천지피판유리이식화대체전이수복사지급경부、액와、견배부피부연조직결손적가행성화림상효과.방법 선용동측대혈관체흉배동맥천지피판수복5례경부、액와、견배부창면；선용흉배동맥천지피판유리이식수복11례사지골외로혹기건외로창면.기중12례이흉배동정맥-외측지-천지위혈관체,4례이흉배동정맥-전거기지-천지위혈관체,피판불휴대심근막、배활기화흉배신경.피판면적최소10 cm×5 cm,최대26 cm×10 cm.결과 술후16례피판전부성활,공구여수구창면일기유합.술후수방3～ 24개월,피판질지량호、외형불옹종,피판공구반흔불명현,견관절공능무영향.결론 흉배동맥천지피판질지량호、공구은폐、혈관체장、혈공가고,차불희생배활기화흉배신경.대체전이시수복동측경、견、액와피부연조직결손적이상방법,유리이식괄합수복사지피부연조직결손.
Objective To investigate the effects of free and pedicled thoracodorsal artery perforator (TDAP) flaps for repairing skin and soft tissue defects in limbs、neck、axillary and shoulder.Methods From October 2009 to Auguest 2011,16 TDAP flaps were used to repair skin and tissue defects.Among them,five ipsilateral pedicled flaps were used to repair wounds in neck,axillary and shoulder.11 free TDAP flaps were used to repair the wounds with bone or tendon exposure.In 12 cases,the flaps were pedicled with thoracodorsal artery and vein-lateral branches-perforators,in 4 cases,pedicled with thoracodorsal artery and vein-serratus anterior muscular branches-perforators.The deep fascia,the latissimus dorsi and thoracodorsal nerve were not included in all flaps.The flaps size ranged from 10 cm × 5 cm to 26 cm × 10 cm.Results A11 16 flaps survived completely with primary healing both at donor site and recipent area.After a follow-up of 3 to 24 months,all flaps gained good texture and appearance.Only linear scar was left at donor area.The shoulder could move freely.Conclusions TDAP flap has good texture,long vascular pedicle,and reliable blood supply,leaving less morbidity at donor site.The latissimus dorsi and thoracodorsal nerve are also preserved.The pedicled TDAP flap is an ideal flap for repairing the ipsilateral skin and soft tissue defects of the neck,shoulder,axillary.The free TDAP flap is suited for repairing skin and soft tissue defects of the extremities.