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目的探讨带蒂轴型背部肌皮瓣在邻近部位深度创面修复中的应用。方法 2005年至2010年中南大学湘雅医院烧伤整形外科采用轴型背部肌皮瓣转移修复邻近部位深度创面22例。烧(创)伤创面彻底清创、溃疡和肿瘤切除后采用胸背动脉为蒂的背阔肌肌皮瓣14例,背阔肌肌皮瓣联合髂腰皮瓣3例,联合胸大肌皮瓣1例,腰动脉和肋间后血管为蒂的逆行背阔肌肌皮瓣1例,下位斜方肌肌皮瓣3例。结果背阔肌肌皮瓣转移术后感染或远端部分坏死各1例;4例供瓣区植皮部分未成活,经再次扩创或二期植皮后愈合。其余组织瓣移植未见并发症发生。随访3～24月,修复部位功能和外观均基本满意。结论带蒂轴型背部肌皮瓣能满足颈、胸、上肢等深度创面覆盖的需要,可安全、有效地修复这些部位的深度创面。
Objective To explore the application of pedicle axial dorsal muscle flap in the repair of deep wounds in the proximal part. Methods From 2005 to 2010, 22 cases of deep wounds in the proximal part were repaired by axial dorsalis pedis muscle flap transfer in Xiangya Hospital of Central South University. Fatal wounds were completely debridement, 14 cases of latissimus dorsi myocutaneous flap pedicled with thoracodorsal artery after ulcer and tumor resection, 3 cases latissimus dorsi myocutaneous flap combined with iliopsoas flap, 1 case of flap, 1 case of retrograde latissimus dorsi myocutaneous flap pedicled with lumbar artery and posterior intercostal artery, and 3 cases of trapezius myocutaneous flap. Results 1 case of infection or distal necrosis of latissimus dorsi myocutaneous flap was observed in 1 case. The skin graft in 4 cases was not alive and was healed again after reimplantation or two-stage skin grafting. The rest of the flap flap transplantation no complications occurred. Followed up for 3 ~ 24 months, the repair site function and appearance are basically satisfied. Conclusions The pedicle axial dorsalis pedis flap can meet the needs of deep wound coverage such as neck, chest and upper extremity, and can safely and effectively repair the deep wounds in these areas.