Zhang J Q, Zhang J M, Liang W Q, Ji C Y, Chen Y H
Sun Yat-sen Memorial Hospital , Guangzhou , China.
Ann R Coll Surg Engl. 2017 Jul;99(6):464-471. doi: 10.1308/rcsann.2017.0055.
INTRODUCTION The aim of this study was to investigate whether the pedicle of the rectus abdominis flap can be lengthened by resecting the inferior costal cartilage segments or associated muscle when repairing upper body defects. A formula was generated that calculates the expected increase in pedicle length. METHODS Thirty patients underwent computed tomography. The width and thickness of the third to seventh inferior costal cartilage segments as well as the width of the respective intercostal spaces were recorded. Four patients underwent reconstruction of an upper body defect with the relevant flap. RESULTS The expected mean increases in pedicle length were 4.07cm (standard deviation [SD]: 0.31cm) and 4.63cm (SD: 0.54cm) following resection of the left and right sides respectively of the seventh inferior costal cartilage segment, 7.99cm (SD: 0.49cm) and 10.82cm (SD: 0.23cm) following resection of the left and right sides respectively of the sixth and seventh inferior costal cartilage segments while resection of the fourth to seventh inferior costal cartilage segments would equate to increases of 17.48cm (SD: 0.62cm) and 22.05cm (SD: 0.21cm) for the left and right sides respectively. In four patients who required reconstruction, three flaps survived without problems but one flap developed partial necrosis. CONCLUSIONS Resecting inferior costal cartilage segments or associated muscle can lengthen the pedicle of the rectus abdominis flap for reconstruction of defects on the upper chest and neck.
引言 本研究的目的是探讨在修复上身缺损时，通过切除肋软骨下段或相关肌肉，腹直肌皮瓣的蒂部是否能够延长。推导出了一个计算蒂部长度预期增加量的公式。方法 对30例患者进行了计算机断层扫描。记录第三至第七肋软骨下段的宽度和厚度以及相应肋间间隙的宽度。4例患者采用相关皮瓣修复上身缺损。结果 分别切除第七肋软骨下段左右两侧后，蒂部长度预期平均增加量分别为4.07cm（标准差[SD]：0.31cm）和4.63cm（SD：0.54cm）；分别切除第六和第七肋软骨下段左右两侧后，蒂部长度预期平均增加量分别为7.99cm（SD：0.49cm）和10.82cm（SD：0.23cm）；而切除第四至第七肋软骨下段，左右两侧蒂部长度预期平均增加量分别为17.48cm（SD：0.62cm）和22.05cm（SD：0.21cm）。在4例需要进行修复的患者中，3个皮瓣顺利存活，但有1个皮瓣发生了部分坏死。结论 切除肋软骨下段或相关肌肉可延长腹直肌皮瓣的蒂部，用于修复上胸部和颈部的缺损。
