Latissimus dorsi free flap transfer for repair of complex wounds: the complete tissue and functional reconstruction

doi:10.3969/j.issn.2095-4344.2015.15.011

Abstract

Abstract:

BACKGROUND: With the development of microsurgical techniques, free flap transplantation has been widely used, which can solve the problem of insufficient local tissues.
OBJECTIVE: To observe the clinical effects of latissimus dorsi free flap transfer on the repair of all kinds of body surface defects, as well as the role in complete tissue and functional reconstruction.
METHODS: From 2010 to 2013, 18 cases of various types of body surface defects were selected and using the microsurgical techniques, these complex wounds were repaired with free latissimus dorsi myocutaneous flaps. According to defect reason, primary wounds were treated for arteriovenous separation in the recipient zone. Most of the flaps were latissimus dorsi myocutaneous flaps at the affected side which were cut according to the wound size. If the cut muscle flap had a larger size and secondary wounds were difficult to be directly sutured, free skin grafts could be used to cover the residual secondary wounds.
RESULTS AND CONCLUSION: After transplantation, all the flaps survived with normal blood supply and well-recovered function. Patients were more satisfied with the flap appearance. Latissimus dorsi myocutaneous flaps characterized as large donor area and secluded location have a great advantage in the repair of complex wounds using microsurgical techniques that can improve the survival rate of latissimus dorsi myocutaneous flaps.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: Transplantation, Surgical Flaps, Wound Healing

CLC Number:

R318

Yu Bing, Xiong Meng, Lin He, Ma Xiao-jun. Latissimus dorsi free flap transfer for repair of complex wounds: the complete tissue and functional reconstruction[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(15): 2351-2355.

Figures/Tables 1

2.1 参与者数量分析纳入患者18例，按意向性处理分析，全部进入结果分析。 2.2 观察移植肌皮瓣(肌瓣)成活情况本文中18例患者均选取缺损区同侧背阔肌肌皮瓣(肌瓣)游离移植覆盖体表缺损，最大切取范围约35 cm×11c m。其中面部肿瘤造成的体表缺损患者3例，术中切除病变组织，术中快速冰冻报告提示无肿瘤残留，一期覆盖创面。参照对侧面部组织量及组织厚度，背阔肌肌皮瓣过于臃肿，故选择背阔肌肌瓣游离移植，肌瓣表面游离植皮，供区创面直接拉拢缝合。移植肌瓣、皮片完全成活。 2.3 肌皮瓣(肌瓣)移植后功能恢复情况本组患者痊愈后，缺损创面修复良好，修复组织量充足，既达到覆盖创面的目的，同时达到了一定的美观性和功能性要求。半年后，面部创面修复患者根据移植肌皮瓣(肌瓣)萎缩程度、双侧面部对称性等因素，行肌皮瓣(肌瓣)修薄等手术，使面部外观及对称性更加自然，且面部表情活动相对恢复。局部肢体创面修复后，辅以积极的康复治疗，肢体功能恢复较满意。所有患者由于供区瘢痕相对隐蔽，对患者局部外观的的美观性及其生活影响较小，且该部位功能影响小。 2.4 肌皮瓣(肌瓣)移植后不良反应颅面部毁损伤患者1例，外院治疗3 d后转入，予清创、控制感染后，选择背阔肌肌瓣游离移植，移植后由于出现血管危象导致肌瓣坏死，积极清创、换药处理后，以缺损区对侧背部为供区，行背阔肌肌瓣游离移植，移植后观察肌瓣成活良好。外伤致下肢软组织缺损患者14例，移植肌皮瓣(肌瓣)均成活，其中3例出现移植后感染，积极换药后，创口愈合；3例肌瓣表面游离植皮部分坏死，其中2例坏死范围较小，换药后周围新生上皮覆盖创面，1例坏死范围较大，后期补充植皮覆盖创面，1例患者术后局部感染兼有部分移植皮片坏死，积极换药后，创面愈合。7例移植后无严重并发症，供瓣区及受区创面一期愈合。"

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