背阔肌Kiss皮瓣修复上臂复合组织缺损及功能重建

发布时间：2018-12-07 17:58

【摘要】：目的探讨采用背阔肌Kiss皮瓣修复上臂复合组织缺损及功能重建的临床疗效。方法 2010年3月—2016年11月,采用带神经血管束的背阔肌Kiss皮瓣修复12例上臂复合组织缺损。其中男8例,女4例;年龄21~50岁,中位年龄34岁。致伤原因:机械损伤4例,交通事故伤5例,电击伤2例,上臂软组织恶性肿瘤1例。合并三角肌缺损5例,肱三头肌及肱肌损伤4例,三角肌、肱三头肌及肱肌不同程度损伤3例。创面范围13 cm×7 cm~20 cm×8 cm。合并骨折伴骨外露6例,其中1例合并骨缺损。病程3 h~6个月。皮瓣切取范围为10 cm×6 cm~15 cm×7 cm;供区创面直接缝合。结果 12例皮瓣全部成活,供、受区创面均Ⅰ期愈合。10例患者获随访,随访时间6~26个月,平均14个月。末次随访时,移植皮瓣成活良好、质地柔软,颜色接近周围正常皮肤,供区仅见线性瘢痕;肩关节外展活动度达30~90°,肱三头肌肌力均在4级及以上;浅感觉与触觉部分恢复,S1 2例,S_2 6例,S_3 2例。采用中华医学会手外科学会上肢部分功能评定试用标准评定肩关节功能,获优2例,良4例,可4例。结论背阔肌Kiss皮瓣设计灵活,供区可直接拉拢缝合,带神经支配的背阔肌可重建上肢部分外展功能,修复上臂复合组织缺损可获良好疗效。
[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 掳90 掳, 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.
【作者单位】：遵义医学院附属医院烧伤整形外科;
【基金】：国家临床重点专科基金资助项目(国卫办医函[2013]544号)~~
【分类号】：R658.2

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