發(fā)布時(shí)間：2018-12-07 17:58

【摘要】：目的探討采用背闊肌Kiss皮瓣修復(fù)上臂復(fù)合組織缺損及功能重建的臨床療效。方法 2010年3月—2016年11月,采用帶神經(jīng)血管束的背闊肌Kiss皮瓣修復(fù)12例上臂復(fù)合組織缺損。其中男8例,女4例;年齡21~50歲,中位年齡34歲。致傷原因:機(jī)械損傷4例,交通事故傷5例,電擊傷2例,上臂軟組織惡性腫瘤1例。合并三角肌缺損5例,肱三頭肌及肱肌損傷4例,三角肌、肱三頭肌及肱肌不同程度損傷3例。創(chuàng)面范圍13 cm×7 cm~20 cm×8 cm。合并骨折伴骨外露6例,其中1例合并骨缺損。病程3 h~6個(gè)月。皮瓣切取范圍為10 cm×6 cm~15 cm×7 cm;供區(qū)創(chuàng)面直接縫合。結(jié)果 12例皮瓣全部成活,供、受區(qū)創(chuàng)面均Ⅰ期愈合。10例患者獲隨訪,隨訪時(shí)間6~26個(gè)月,平均14個(gè)月。末次隨訪時(shí),移植皮瓣成活良好、質(zhì)地柔軟,顏色接近周?chē)Ｆつw,供區(qū)僅見(jiàn)線性瘢痕;肩關(guān)節(jié)外展活動(dòng)度達(dá)30~90°,肱三頭肌肌力均在4級(jí)及以上;淺感覺(jué)與觸覺(jué)部分恢復(fù),S1 2例,S_2 6例,S_3 2例。采用中華醫(yī)學(xué)會(huì)手外科學(xué)會(huì)上肢部分功能評(píng)定試用標(biāo)準(zhǔn)評(píng)定肩關(guān)節(jié)功能,獲優(yōu)2例,良4例,可4例。結(jié)論背闊肌Kiss皮瓣設(shè)計(jì)靈活,供區(qū)可直接拉攏縫合,帶神經(jīng)支配的背闊肌可重建上肢部分外展功能,修復(fù)上臂復(fù)合組織缺損可獲良好療效。
[Abstract]:Objective to evaluate the clinical effect of latissimus dorsi Kiss flap in repairing complex tissue defect of upper arm. Methods from March 2010 to November 2016, latissimus dorsi (latissimus dorsi) Kiss flap with neurovascular bundle was used to repair 12 cases of upper arm composite tissue defect. There were 8 males and 4 females, the age was 21 50 years old, the median age was 34 years old. The causes of injury were mechanical injury (4 cases), traffic accident (5 cases), electric injury (2 cases) and soft tissue malignant tumor (1 case). There were 5 cases with deltoid muscle defect, 4 cases with triceps and brachialis injury, 3 cases with deltoid muscle, triceps brachii and brachialis muscle. Wound area 13 cm 脳 7 cm~20 cm 脳 8 cm. 6 cases were complicated with fracture and bone exposure, of which 1 case was complicated with bone defect. The course of disease was 3 h ~ 6 months. The skin flap was directly sutured for 10 cm 脳 6 cm~15 cm 脳 7 cm; donor area. Results all the 12 flaps survived, and all the wounds were healed in the first stage. 10 cases were followed up for 6 ~ 26 months (mean 14 months). At the last follow-up, the skin flap survived well, soft, close to the surrounding normal skin, and only linear scar was seen in the donor area, the abduction of shoulder joint reached 30 擄90 擄, and the muscle strength of triceps brachii muscle was grade 4 and above. Partial recovery of superficial sensation and tactile sensation was found in 2 cases of S 1, 26 cases of S _ 2 and 32 cases of S _ 2. The function of shoulder joint was evaluated according to the evaluation criteria of the upper limb function of the Chinese Medical Association. The results were excellent in 2 cases, good in 4 cases and fair in 4 cases. Conclusion the Kiss flap of latissimus dorsi can be designed flexibly, the donor area can be closed and sutured directly. The latissimus dorsi muscle with nerve innervation can reconstruct the function of partial abduction of upper limb, and the repair of composite tissue defect of upper arm can obtain good curative effect.
【作者單位】： 遵義醫(yī)學(xué)院附屬醫(yī)院燒傷整形外科;
【基金】：國(guó)家臨床重點(diǎn)�？苹鹳Y助項(xiàng)目(國(guó)衛(wèi)辦醫(yī)函[2013]544號(hào))~~
【分類(lèi)號(hào)】：R658.2

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