單側超量擴張的背闊肌肌皮瓣修複女性胸部大麵積攣縮瘢痕
整形美容
作者：田佳 範金財 白永強 等
[摘要]目的：介紹利用超量擴張的背闊肌肌皮瓣修複女性胸部正中大麵積攣縮瘢痕的手術方法，探討其在應用方麵的優勢，為臨床推廣應用提供參考。方法：2009年-2014年，筆者使用本方法對16例燒傷後胸部正中大麵積瘢痕的女性患者進行修複。使用800ml長方形擴張器擴張單側背闊肌肌皮瓣，超量擴張2.5倍以上。擴張完成後，取出擴張器，以皮下隧道方式將擴張肌皮瓣轉移至胸部，修複胸部正中瘢痕。供區一期縫合。結果：全部皮瓣均成活良好.平均皮瓣麵積為28cm×22cm。擴張器擴張及手術過程中出現個別並發症，經積極處理，未對最終手術結果照成影響。術後患者功能外觀改善明顯，皮瓣顏色質地良好，回縮率低，效果穩定。供區均一期愈合，未見明顯背部畸形或肩關節活動障礙。結論：單側超量擴張的背闊肌肌皮瓣修複女性胸部正中大麵積瘢痕臨床效果好，組織量充足，供區隱蔽，是較為理想的修複方法。皮瓣血運穩定，手術操作相對簡單，易於推廣。
[關鍵詞]胸部瘢痕；超量擴張；背闊肌肌皮瓣
[中圖分類號]R619+.6 [文獻標誌碼]A [文章編號]1008-6455（2015）12-0001-04
Use unilateral excessive expanded latissimus dorsi myocutaneous flap for large contracted scar of female central chest repairment
TIAN Jia，FAN Jin-cai，BAI Yong-qiang，LIU Li-qiang，GAN Cheng，YANG Zeng-jie，JIAO Hu，
CHEN Wen-lin，YIN Zhu-ming，HAN Bing，XUE Bing-jian
（The Ninth Department of Plastic Surgery，Plastic Surgery Hospital，Chinese Academy of Medical Sciences， Peking Union Medical College，Beijing 100144，China）
Abstract： Objective To introduce using unilateral excessive expanded latissimus dorsi myocutaneous flap for the repairment of large contracted scar in the central part of female chest. Evaluate this method and provide a reference for the clinical selection of appropriate treatment options. Methods From 2009 to 2014，16 female burn sequala patients underwent this two-staged operation for large contracted scar in the central part of chest reconstruction.A rectangle tissue expander （800ml） was inserted underneath unilateral latissimus dorsi in the first stage.After being expanded excessively over 2.5 times of the design capacity，the tissue expender was removed and the expanded myocutaneous flap was transferred to the central chest area via subcutaneous tunnel. The donor site was closed primarily. Results All flaps survived.The average size of the flaps was 28cm×22cm.A few minor complications happened during the expanding and the post-operational period，which were controlled by positive treatments without affecting the final results.The appearance and function of the patients had improved significantly.The retraction rate of the flaps was low，the results were stable.The donor site healed without morbidity or obvious shoulder dysfunction. Conclusion Unilateral excessive expanded latissimus dorsi myocutaneous flap provides abundant tissue for large contracted scar repairment in the central part of female chest with donor site being well-concealed and preserved. This is a simple and safe method， which is worth recommended.