Osinga R, Mazzone L, Meuli M, Meuli-Simmen C, von Campe A
Clinic of Hand, Reconstructive and Plastic Surgery, Kantonsspital Aarau, Aarau, Switzerland.
Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
J Plast Reconstr Aesthet Surg. 2014 Aug;67(8):1070-5. doi: 10.1016/j.bjps.2014.04.018. Epub 2014 May 2.
The latissimus dorsi flap (LDF) has been employed very successfully over decades to cover large soft-tissue defects. Its donor-site morbidity has been extensively investigated in adults - but not in children - and is considered to be nonrestrictive. The aim of this long-term study was to assess donor-site morbidity with the modified Constant score more than 8 years after coverage of large myelomeningocele (MMC) defects with a reverse latissimus dorsi flap.
Within the first days after birth, the reverse latissimus dorsi muscle flap was used uni- or bilaterally in three neonates to cover a large MMC defect. Bilateral shoulder function was tested more than 8 years postoperatively according to the modified Constant score.
The mean age at follow-up was 11.7 years. None of the patients experienced any pain or shoulder restrictions during normal daily activities. They all managed to position both of their arms comfortably above the head. Forward flexion was normal in all patients as was abduction and external rotation. Dorsal extension was minimally reduced on the operated side. Internal rotation was symmetric in all patients; the extent of active movement varied from excellent to poor.
Our long-term data suggest that there is no specific and significant impairment of shoulder function after using the distally pedicled reverse LDF for neonatal MMC repair.
几十年来，背阔肌肌皮瓣（LDF）一直非常成功地用于覆盖大面积软组织缺损。其供区并发症在成人中已得到广泛研究，但在儿童中尚未有研究，且被认为无明显限制。本长期研究的目的是在用逆行背阔肌肌皮瓣覆盖大型脊髓脊膜膨出（MMC）缺损8年多后，用改良Constant评分评估供区并发症情况。
在出生后的头几天，对3例新生儿单侧或双侧使用逆行背阔肌肌皮瓣覆盖大型MMC缺损。术后8年多，根据改良Constant评分对双侧肩部功能进行测试。
随访时的平均年龄为11.7岁。所有患者在日常活动中均未经历任何疼痛或肩部活动受限。他们都能够将双臂舒适地举过头顶。所有患者的前屈、外展和外旋均正常。患侧的背伸稍有减弱。所有患者的内旋均对称；主动活动范围从优到差不等。
我们的长期数据表明，在新生儿MMC修复中使用远端带蒂逆行LDF后，肩部功能没有特定且明显的损害。
