Pinsolle V, Tessier R, Casoli V, Martin D, Baudet J
Service de Chirurgie Plastique, CHU Bordeaux/Université Bordeaux 2, Hopital Pellegrin Tondu, Place amelie Raba-Leon, 33076 Bordeaux, Cedex, France.
J Plast Reconstr Aesthet Surg. 2007;60(9):1019-24. doi: 10.1016/j.bjps.2007.03.028. Epub 2007 May 11.
The vascularised scapular bone free flap is popular in mandible reconstruction, but it is less commonly used as a pedicled flap to reconstruct the upper humerus. We analysed our experience with pedicled scapular crest flaps in humerus reconstruction and compared our results with cases reported in the literature. We considered the age at surgery, the time elapsed before reconstruction, the time required to obtain solid bony union, the operative indication, the osteosynthesis procedure used and whether circumflex scapular vessels or angular vessels were used. There were eight patients (seven men and one woman, mean age=33): four humerus stump lengthenings, two upper-third humerus bone and soft tissue defects and two multioperated established humerus non-unions. Flaps were pedicled either on circumflex scapular vessels (three) or angular vessels (five). The mean size of the scapular bone used was 9.4 cm (range 7-11 cm). We associated a covering flap for seven patients. All the flaps survived and bone healed in a 3.75 month mean delay (range three to six months), and there was one accidental secondary fracture one year after reconstruction. For a vascularised reconstruction of the upper humerus, the pedicled scapular bone flap is a valuable option especially if a composite reconstruction is needed. For short humerus stump lengthening, this flap seems to provide a very satisfactory solution.
带血管蒂的肩胛游离骨瓣在颌骨重建中应用广泛，但作为带蒂皮瓣用于重建肱骨近端则较少见。我们分析了使用带蒂肩胛嵴皮瓣重建肱骨的经验，并将结果与文献报道的病例进行比较。我们考虑了手术时的年龄、重建前的时间间隔、获得牢固骨愈合所需的时间、手术指征、所采用的骨固定方法以及使用的是旋肩胛血管还是角血管。共有8例患者（7例男性，1例女性，平均年龄33岁）：4例肱骨残端延长术、2例肱骨上1/3骨与软组织缺损以及2例多次手术形成的肱骨骨不连。皮瓣分别以旋肩胛血管（3例）或角血管（5例）为蒂。所用肩胛骨的平均大小为9.4 cm（范围7 - 11 cm）。我们为7例患者联合应用了覆盖皮瓣。所有皮瓣均存活，骨愈合平均延迟3.75个月（范围3至6个月），重建后1年发生1例意外继发性骨折。对于肱骨近端的血管化重建，带蒂肩胛骨瓣是一种有价值的选择，尤其是在需要复合重建时。对于短肱骨残端延长，该皮瓣似乎能提供非常满意的解决方案。
