摘要
目的探讨背阔肌皮瓣游离移植修复小儿四肢远端巨大软组织缺损的临床效果。方法2005年3月～2007年12月,对小儿四肢远端巨大软组织缺损采用背阔肌皮瓣游离移植修复8例。其中男5例,女3例,年龄4～12岁。病程:2 h～10天。全部为交通事故伤。其中小腿合并足踝、足背部皮肤不同程度缺损6例,前臂合并腕、手部皮肤不同程度缺损2例,所有病例均有不同程度的肌腱、骨组织缺损、外露,2例合并感染。缺损范围12cm×5cm～21cm×12cm;切取背阔肌皮瓣13cm×6cm～23cm×13cm,供区均采用大张中厚皮片移植覆盖或直接缝合。结果术后8例背阔肌皮瓣全部成活,无血管危象和感染发生,创面均Ⅰ期愈合;6例供区植皮2例部分坏死,其中1例经换药后治愈,1例二期植皮修复;2例供区直接缝合,伤口愈合良好。术后获随访3～8个月,成活的皮瓣质地优良,外观比较满意。结论小儿背阔肌皮瓣血运丰富,抗感染能力强,切取范围大,皮瓣相对较薄,是修复小儿四肢远端巨大皮肤软组织缺损和骨、肌腱外露、感染创面的一种理想皮瓣。
Objective To explore the results of repairing widespread traumatic soft tissue defects in upper and lower extremity of child with free latissimus dorsi muscle skin flaps.Methods From March 2005 to December 2007, 8 cases of widespread traumatic soft tissue defects in the upper or lower extremity of child were repaired with free latissimus dorsi muscle skin flaps.Of the 8 patients,5 were male and 3 was female,whose ages ranged from 4 to 12 years,and the disease course was 2 hours to 10 days.The defect was by crush injury in 8 cases. Six cases of defects involved in the crus and ankle and the dorsal of foot,Two cases of defects involved in the forearm and wrist and the back of hand.All cases were accompanied by the exposure of bone and tendon.Two cases by open infection.The defect area ranged from 12 cm×5 cm to 21 cm×12 cm.The sizes of the dissected flap ranged from 13cm×6cm to 23cm×13cm.The donor sites were covered by large mid thickness flap or suture.Results There were no postoperative complication of vascular crisis and infection.Eight flaps survived completely and the wounds healed by first intention.Four of the six flaps survived and the other two suffered necrosis in part;After a follow-up of 3 to 8 months,The flaps still appeared good with satisfying skin texture.Conclusion The free latissimus dorsi muscle skin flap is an ideal flap for repairing widespread traumatic soft tissue defects and infectious wounds wi th bone and tendon exposure in the upper or lower extremity of child, because it has such advantages as adequate blood supply,big dermatomic area,comparatively thin and excellent ability to resist infection.
关键词
背阔肌皮瓣
游离移植
四肢
巨大软组织缺损
Latissimus dorsimuscle skin flap
Free transplantation
Extremities
Massive soft tissue deformities
