Mathes David W, Thornton James F, Rohrich Rod J
Department of Plastic Surgery, University of Texas Southwestern Medical School, Dallas, Texas 75390-9132, USA.
Plast Reconstr Surg. 2006 Sep;118(3):73e-83e. doi: 10.1097/01.prs.0000233130.93861.15.
After studying this article, the participant should be able to: 1. Discuss nomenclature and anatomy associated with reconstruction of the back. 2. Perform preoperative assessment, decision making, and counseling of patients. 3. Describe current surgical planning, including careful analysis of the defect and appropriate selection of tissue to provide coverage while maximizing form and function.
The plastic surgeon is called to reconstruct defects in the posterior truck that involve an extensive zone of injury. Simple solutions, such as wide undermining and primary closure, will not result in a stable closed wound. Successful closure of these wounds depends on preoperative evaluation of tissue needs and host defects, and selection of the most appropriate flap to close dead space and provide vascularized tissue to the wound bed.
The authors examined the literature regarding the available treatment options surrounding reconstruction of posterior back wounds. They review the important details surrounding the use of each flap and present select cases from their own experience regarding reconstruction of the back.
: The posterior trunk benefits from multiple flaps that can be used in reconstruction of the back. The wound must be evaluated in terms of tissue requirements and host issues, such as infection or previous radiation. Most wounds can be closed in a single stage, after careful flap section based on the wound's needs and anatomic location, with minimal postoperative complications. Early and aggressive treatment of these wounds improves patient outcomes and can reduce the time spent in hospital.
Reconstruction of the posterior trunk depends on careful analysis of the tissue defects, host issues, and application of functional anatomy. The majority of wounds can be reconstructed after thorough débridement with a vascularized muscle flap.
在研读本文后，参与者应能够：1. 讨论与背部重建相关的命名法和解剖结构。2. 对患者进行术前评估、决策制定和咨询。3. 描述当前的手术规划，包括对缺损的仔细分析以及组织的适当选择，以在最大化形态和功能的同时提供覆盖。
整形外科医生被要求重建后躯干中涉及广泛损伤区域的缺损。简单的解决方案，如广泛潜行分离和一期缝合，不会产生稳定的闭合伤口。这些伤口的成功闭合取决于对组织需求和宿主缺损的术前评估，以及选择最合适的皮瓣来闭合死腔并为伤口床提供带血管的组织。
作者查阅了有关后背部伤口重建的可用治疗方案的文献。他们回顾了使用每个皮瓣的重要细节，并展示了他们自己在后背部重建经验中的精选病例。
后躯干可受益于多种可用于背部重建的皮瓣。必须根据组织需求和宿主问题（如感染或既往放疗史）对伤口进行评估。在根据伤口需求和解剖位置仔细选择皮瓣后，大多数伤口可以一期闭合，术后并发症最少。对这些伤口进行早期积极治疗可改善患者预后并减少住院时间。
后躯干的重建取决于对组织缺损、宿主问题的仔细分析以及功能解剖学的应用。大多数伤口在彻底清创后可用带血管的肌皮瓣进行重建。
