Bethesda and Baltimore, Md.; Washington, D.C.; and Pittsburgh, Pa. From the Division of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center; the Department of Plastic and Reconstructive Surgery, Georgetown University; Johns Hopkins University School of Medicine; Uniformed Services University of Health Sciences; and the Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center.
Plast Reconstr Surg. 2013 Oct;132(4):577e-585e. doi: 10.1097/PRS.0b013e31829f4a08.
Combat injuries commonly result in massive bony and soft-tissue destruction within the extremities. These extremity wounds often require large free tissue transfers and/or composite flaps for definitive reconstruction. In U.S. military war trauma experience, the authors' practice has found the scapular flap increasingly useful for reconstruction of complex extremity injuries. The purpose of this study is to report the authors' experience using the scapular flap in extremity reconstruction and evaluate the indications for use in the authors' patient population.
All consecutive limb salvage cases requiring free flaps from 2009 to 2012 at Walter Reed National Military Medical Center were reviewed retrospectively. Scapular flap cases were identified. Data collected included Injury Severity Score, flap characteristics, and complications.
Twelve scapular free flaps were performed for extremity reconstruction for combat-related trauma, representing 16.2 percent of all microsurgical reconstructions during that period. Cases included eight traditional scapular flaps, two osteocutaneous scapular flaps, one chimeric latissimus/scapular flap, and one chimeric parascapular/scapular/scapula bone flap. The complication rate was 17 percent, consisting of one flap hematoma and one donor-site dehiscence. Complication rates were similar between scapular flaps, other fasciocutaneous flaps, and muscle flaps.
In a decade of war trauma, the authors' practice has found the scapular flap useful for reconstruction of complex extremity injuries. This flap is uniquely suited to the authors' patients, given the severity of their injuries and rehabilitation needs. The scapular flap continues to have various indications in injuries seen within the authors' military population that may be applicable to the authors' civilian patient counterparts.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
战斗损伤通常会导致四肢的大量骨和软组织破坏。这些四肢伤口通常需要大的游离组织转移和/或复合皮瓣进行确定性重建。在美国军事战创伤经验中，作者的实践发现肩胛骨皮瓣越来越有助于重建复杂的四肢损伤。本研究的目的是报告作者在四肢重建中使用肩胛骨皮瓣的经验，并评估在作者的患者群体中使用的适应证。
回顾性分析 2009 年至 2012 年期间在 Walter Reed 国家军事医学中心因需要游离皮瓣而行保肢手术的所有连续肢体病例。确定肩胛骨皮瓣病例。收集的数据包括损伤严重程度评分、皮瓣特征和并发症。
12 例肩胛骨游离皮瓣用于治疗与战斗相关创伤的四肢重建，占同期所有显微重建的 16.2%。病例包括 8 例传统的肩胛骨皮瓣、2 例骨皮肩胛骨皮瓣、1 例嵌合背阔肌/肩胛骨皮瓣和 1 例嵌合肩胛旁/肩胛骨/肩胛骨骨瓣。并发症发生率为 17%，包括 1 例皮瓣血肿和 1 例供区裂开。肩胛骨皮瓣、其他筋膜皮瓣和肌肉瓣的并发症发生率相似。
在过去十年的战争创伤中，作者的实践发现肩胛骨皮瓣对复杂的四肢损伤重建有用。鉴于患者损伤的严重程度和康复需求，这种皮瓣非常适合作者的患者。肩胛骨皮瓣在作者的军事人群中所见的各种损伤中仍有各种适应证，可能适用于作者的平民患者。
临床问题/证据水平：治疗，IV。
