CAJ | 학술논문

目的：探讨异型动脉血管为蒂的游离背阔肌肌皮瓣修复合并大段主干血管缺损的大面积软组织缺损的临床可行性。方法2011年1月—2013年6月，采用带肩胛下动脉及旋肩胛动脉的游离背阔肌肌皮瓣修复合并大段主干血管缺损的大面积软组织缺损4例，其中桡动脉缺损3例，胫前动脉缺损1例，血管缺损达4.0～6.0 cm，4例均二期修复。根据创面大小设计带肩胛下动脉及旋肩胛动脉的游离背阔肌肌皮瓣修复创面，将血管蒂嵌入桥接受区主干血管缺损处，分别与近、远端血管形成“T”形或“Y”形吻合。在保证皮瓣血运同时，重建肢体远端血液循环。静脉一支与伴行静脉吻合，另一支可与浅静脉吻合。术后密切观察皮瓣及肢体远端血运。结果术后4例皮瓣成活，未发生血管危象，肢体远端血液循环正常。随访6～24个月，皮瓣质地、外形良好，供区功能无影响。结论异型动脉血管为蒂的游离背阔肌肌皮瓣修复合并大段主干动脉缺损的软组织缺损，既能保证皮瓣血运又能重建肢体主干血管的连续性，保证肢体正常血供，手术操作与一般游离背阔肌肌皮瓣无异，临床应用简单，对修复伴有大段主干血管缺损的大面积软组织缺损不失为一种较好的方式。
목적：탐토이형동맥혈관위체적유리배활기기피판수복합병대단주간혈관결손적대면적연조직결손적림상가행성。방법2011년1월—2013년6월，채용대견갑하동맥급선견갑동맥적유리배활기기피판수복합병대단주간혈관결손적대면적연조직결손4례，기중뇨동맥결손3례，경전동맥결손1례，혈관결손체4.0～6.0 cm，4례균이기수복。근거창면대소설계대견갑하동맥급선견갑동맥적유리배활기기피판수복창면，장혈관체감입교접수구주간혈관결손처，분별여근、원단혈관형성“T”형혹“Y”형문합。재보증피판혈운동시，중건지체원단혈액순배。정맥일지여반행정맥문합，령일지가여천정맥문합。술후밀절관찰피판급지체원단혈운。결과술후4례피판성활，미발생혈관위상，지체원단혈액순배정상。수방6～24개월，피판질지、외형량호，공구공능무영향。결론이형동맥혈관위체적유리배활기기피판수복합병대단주간동맥결손적연조직결손，기능보증피판혈운우능중건지체주간혈관적련속성，보증지체정상혈공，수술조작여일반유리배활기기피판무이，림상응용간단，대수복반유대단주간혈관결손적대면적연조직결손불실위일충교호적방식。
Objective To investigate the clinical feasibility of the free latissimus dorsi myocutaneous flap supplied with heterotypic artery blood to repair soft tissue defect. Methods 4 cases are large soft tissue and major artery defect repaired by the free latissimus dorsi myocutaneous flap including subscapular artery and circumflex scapular artery. Radial artery loss (3 cases), anterior tibial artery (1 case), the average artery loss is 4.0~6.0 cm. 4 cases are secondary repaired. To design the free latissimus dorsi myocutaneous flap according to the wound surface. The heterotypic artery is inserted to receptive area with artery loss, and then we make the vascular anastomosis by "T" or "Y" type, meanwhile, blood circulation of the distal limb is reconstructed. We make Vascular anastomosis between one vein to one accompany vein, one vein to one superficial vein. Observing blood circulation of the distal limb and the flap carefully. Results The free latissimus dorsi myocutaneous flaps all survived, without blood vessel crisis, and the blood circulation of the distal limb was well. Following up 6~24 monthes, the shape and texture of flaps were well, there was no effect on donor area function. Conclusion It has advantages that larger soft tissue and major artery loss is repaired by the free latissimus dorsi myocutaneous flap with heterotypic artery blood supply. One is the blood circulation of the distal limb and free flap can be reconstructed well, the other is the opereation has no difference from the free latissimus dorsi myocutaneous flap operation, furthermore, this clinical application is simple. It is a good method to repair larger soft tissue and major artery defect.