Boa Olivier, Servant Jean-Marie, Revol Marc, Salib Emmanuel G, Guberman Daniel, Harris Patrick G, Danino Alain M
Plastic Surgery Department, Centre Hospitalier de l'Université de Montréal, Pavillon Hôpital Notre-Dame, Montreal University, Montreal, Quebec, Canada.
Tech Hand Up Extrem Surg. 2011 Sep;15(3):166-71. doi: 10.1097/BTH.0b013e31820a80bc.
The latissimus dorsi, whether taken as a muscle or with a skin paddle, is one of the most useful flaps in the reconstructive surgeon's arsenal. With its predictable type V vascular pedicle, this broad muscle can be elevated on its dominant thoracodorsal pedicle or used in a reverse manner on its secondary thoracic and lumbar perforators. Traditionally harvested in a lateral decubitus position, over the last 10 years we have chosen to elevate this muscle in a dorsal decubitus position, enabling 2 surgical teams to operate simultaneously. With only one cushion placed along the vertebral column between the scapulas, each element of the subscapular system, including scapular bone, can be used to reconstruct complex upper limb defects. A vertical incision in front of the anterior axillary line is performed to identify the anterior border of the muscle, followed by a dissection in the submuscular plane to reveal the thoracodorsal pedicle and its branches. When a more complex chimeric flap is required, scapular bone, serratus muscle, and scapular or parascapular fasciocutaneous flaps are all available. To achieve the longest length possible, the pedicle can be isolated from the axillary vessels. The most common complications are related to donor site, with seroma and delayed wound healing being the most prevalent. Complaints of shoulder pain and functional disability were rare and mostly encountered in the first 2 weeks postoperatively.
背阔肌，无论作为肌肉瓣还是携带皮瓣，都是重建外科医生武器库中最有用的皮瓣之一。凭借其可预测的Ⅴ型血管蒂，这块宽阔的肌肉可以在其主要的胸背血管蒂上掀起，也可以以相反的方式用于其次要的胸腰穿支血管。传统上是在侧卧位进行切取，在过去10年里，我们选择在俯卧位掀起这块肌肉，这样可以使两个手术团队同时进行手术。仅在肩胛骨之间沿脊柱放置一个垫子，肩胛下系统的每个部分，包括肩胛骨，都可用于重建复杂的上肢缺损。在腋前线前方做一个垂直切口以确定肌肉的前缘，然后在肌下平面进行解剖以显露胸背血管蒂及其分支。当需要更复杂的嵌合皮瓣时，肩胛骨、前锯肌以及肩胛或肩胛旁筋膜皮瓣都可供使用。为了获得尽可能长的血管蒂，可以将其与腋血管分离。最常见的并发症与供区有关，血清肿和伤口愈合延迟最为普遍。肩部疼痛和功能障碍的主诉很少见，大多出现在术后的头2周内。
