Liu Zhiyuan, Tang Xiujun, Wang Dali, Wei Zairong, Jin Wenhu, Deng Chengliang, Qi Jianping
Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China.
Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Sep 15;31(9):1106-1110. doi: 10.7507/1002-1892.201704047.
To investigate the effectiveness of latissimus dorsi Kiss flap for repairing composite tissue defects and functional reconstruction of upper arm.
Between March 2010 and November 2016, 12 cases of composite tissue defects of upper arm were repaired by latissimus dorsi Kiss flap with blood vessel and nerve bunch. There were 8 males and 4 females with a median age of 34 years (range, 21-50 years). The reason of injury included plowing mechanical injury in 4 cases, traffic accident injury in 5 cases, electrical injury in 2 cases, and resecting upper arm soft tissue sarcoma in 1 case. There were deltoid defect in 5 cases, triceps brachii and brachialis defect in 4 cases, and deltoid, triceps brachii, and brachialis damaged in varying degrees in 3 cases. The defect area ranged from 13 cm×7 cm to 20 cm×8 cm. Among them, there were 6 cases of fracture combined with partial bone exposure, one of them with bone defect. The disease duration was 3 hours to 6 months. The flap size ranged from 10 cm×6 cm to 15 cm×7 cm, and the donor sites were directly sutured.
Twelve flaps survived with primary healing of wounds. Ten patients were followed up 6-26 months (mean, 14 months). At last follow-up, the flaps were soft and the skin color was similar to the surrounding skin. No obvious scar was found at donor sites. The abduction range of motion of shoulder was 30-90°. The muscle strength of brachialis were all at grade 4 or above. The superficial sensation and tactile sensation recovered partialy (S in 2 cases, S in 6 cases, S in 2 cases). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the shoulder joint function was excellent in 2 cases, good in 4 cases, and fair in 4 cases.
The design of the latissimus dorsi Kiss flaps are flexible, and the donor site can be directly sutured, with the nerves of the latissimus dorsi muscle can partialy reconstruct abduction function of upper arm. In general, the Kiss flap repairing upper arm defect can obtain satisfactory effectiveness.
探讨背阔肌Kiss皮瓣修复上臂复合组织缺损及功能重建的效果。
2010年3月至2016年11月，采用带血管神经束的背阔肌Kiss皮瓣修复12例上臂复合组织缺损。男8例，女4例，年龄中位数34岁（范围21 - 50岁）。致伤原因包括犁耕机械伤4例，交通事故伤5例，电烧伤2例，上臂软组织肉瘤切除术后1例。其中三角肌缺损5例，肱三头肌和肱肌缺损4例，三角肌、肱三头肌和肱肌不同程度损伤3例。缺损面积为13 cm×7 cm至20 cm×8 cm。其中骨折合并部分骨质外露6例，其中1例有骨缺损。病程3小时至6个月。皮瓣大小为10 cm×6 cm至15 cm×7 cm，供区直接缝合。
12例皮瓣全部成活，伤口一期愈合。10例患者获随访6 - 26个月（平均14个月）。末次随访时，皮瓣质地柔软，肤色与周围皮肤相近。供区未见明显瘢痕。肩关节外展活动范围为30° - 90°。肱肌肌力均达4级及以上。浅感觉及触觉部分恢复（S3 2例，S4 6例，S5 2例）。按手外科协会上肢功能评价标准，肩关节功能优2例，良4例，可4例。
背阔肌Kiss皮瓣设计灵活，供区可直接缝合，背阔肌神经能部分重建上臂外展功能。总体而言，Kiss皮瓣修复上臂缺损可获得满意效果。
