Liu Yuanbo, Zang Mengqing, Wu Lehao, Zhu Shan, Chen Bo, Li Shanshan, Han Tinglu, Qu Huayi
From the Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College.
Department of Oncological Orthopedics, Peking University People's Hospital, Peking University.
Ann Plast Surg. 2020 Jun;84(6):689-696. doi: 10.1097/SAP.0000000000002299.
The latissimus dorsi myocutaneous flap is widely used in reconstructive surgery; however, primary donor-site closure remains challenging when a wide flap is harvested.
A large latissimus dorsi myocutaneous flap was elevated and transferred to repair defects. Perforators adjacent to the donor site of the myocutaneous flap were explored using an ultrasound Doppler probe or a technique of extensive exploration along the margins of the donor site wound. A single or multiple perforator propeller flaps based on these perforators were used to close the donor site defect.
From June 2012 to April 2018, this method was used to restore posttraumatic and oncologic defects of the chest wall in 14 cases, upper extremity in 6 cases, and lower extremity in 1 case. The size and width of the latissimus dorsi myocutaneous flaps ranged from 16 × 11 cm to 33 × 17 cm (mean area, 335.6 cm) and 9 cm to 20 cm (mean width, 14 cm), respectively. The donor site defect was closed primarily by using a single flap in 11 cases, dual flap in 9, and triple flap in one. Donor site breakdown was not observed in any of the cases.
The perforator propeller flap could be used to reconstruct a latissimus dorsi myocutaneous flap donor site defect, ensuring not only the harvesting of a wide flap but also achieving primary donor site closure, thus greatly improving the versatility and capability of the latissimus dorsi myocutaneous flap in the reconstruction of large-sized defects.
背阔肌肌皮瓣在重建手术中广泛应用；然而，切取较宽皮瓣时，供区一期闭合仍具有挑战性。
掀起一个大的背阔肌肌皮瓣并转移用于修复缺损。使用超声多普勒探头或沿供区伤口边缘广泛探查的技术来探寻肌皮瓣供区附近的穿支血管。基于这些穿支血管设计单个或多个穿支推进皮瓣来闭合供区缺损。
2012年6月至2018年4月，该方法用于修复14例胸壁创伤后和肿瘤性缺损、6例上肢缺损以及1例下肢缺损。背阔肌肌皮瓣的大小和宽度分别为16×11 cm至33×17 cm（平均面积，335.6 cm）和9 cm至20 cm（平均宽度，14 cm）。11例供区缺损通过单个皮瓣一期闭合，9例采用双皮瓣，1例采用三皮瓣。所有病例均未观察到供区裂开。
穿支推进皮瓣可用于修复背阔肌肌皮瓣供区缺损，不仅能确保切取较宽皮瓣，还能实现供区一期闭合，从而大大提高背阔肌肌皮瓣在修复大型缺损中的通用性和能力。
