Xie Tingjun, Liu Yuanbo, Han Tinglu, Zhu Shan, Zang Mengqing, Chen Bo, Li Shanshan
Scar Comprehensive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Mar 15;35(3):349-355. doi: 10.7507/1002-1892.202009114.
To explore the reliability and effectiveness of soft tissue defect reconstruction using the lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle.
Between December 2014 and December 2019, 13 patients underwent the reconstruction of soft tissue defects in various sites using the lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle. There were 10 males and 3 females, with an average age of 52.1 years (range, 29-83 years). Twelve wounds were resulted from resection of various malignant tumor, including 6 cases of head and neck tumors, 5 cases of shoulder and back tumors, 1 case of chest and back tumors. Among the 12 cases, 4 cases were complicated with wound infection and bone exposure, 1 case with skull defect and cerebral dura exposure, and 1 case with wound infection, skull necrosis, and cerebrospinal fluid leakage. One case was injured in a traffic accident, which resulted in infection wound in the back and shoulder and bone exposure. The sizes of the defect and musculocutaneous flap ranged from 11 cm×7 cm to 23 cm×15 cm and 25 cm×8 cm to 40 cm×14 cm, respectively. According to the spatial relationship between the donor and recipient sites, propeller flaps (8 cases) or percutaneous tunnel island flaps (5 cases) were used to transfer the myocutaneous flap to the recipient area to repair the wound. The donor site was directly closed and sutured in 9 cases, and those with excessive tension were repaired with free skin grafts in 2 cases or transferred flaps in 2 cases.
After the operation, necrosis of the distal 4-cm of the musculocutaneous flap occurred in 2 cases. After debridement, the resultant wounds were reconstructed using a local flap and a posterior intercostal artery perforator flap, respectively. The remaining 11 myocutaneous flaps survived completely without arteries and veins crisis. The wounds in the donor and recipient areas healed by first intention. All the patients were followed up 1 to 48 months (mean, 7.4 months). The color and texture of the flap were good. During the follow-up, 1 patient underwent tumor resection again due to tumor recurrence, and 1 patient with a scalp hemangiosarcoma died due to unexplained thoracic hemorrhage. Tumor recurrence was not found in the remaining patients. The musculocutaneous flap coverage was stable and the infection was controlled.
The lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle can be an alternation option to reconstruct refractory wounds with exposure of vital structures and organs and infection.
探讨携带部分背阔肌的下斜方肌肌皮瓣修复软组织缺损的可靠性及有效性。
2014年12月至2019年12月，13例患者采用携带部分背阔肌的下斜方肌肌皮瓣修复不同部位的软组织缺损。其中男性10例，女性3例，平均年龄52.1岁（范围29 - 83岁）。12例伤口因各种恶性肿瘤切除所致，包括头颈部肿瘤6例、肩背部肿瘤5例、胸背部肿瘤1例。12例中，4例合并伤口感染及骨外露，1例合并颅骨缺损及硬脑膜外露，1例合并伤口感染、颅骨坏死及脑脊液漏。1例因交通事故受伤，导致肩背部感染伤口及骨外露。缺损及肌皮瓣大小分别为11 cm×7 cm至23 cm×15 cm和25 cm×8 cm至40 cm×14 cm。根据供区与受区的空间关系，采用推进皮瓣（8例）或经皮隧道岛状皮瓣（5例）将肌皮瓣转移至受区修复创面。9例供区直接拉拢缝合，2例张力过大者采用游离皮片修复，2例采用转移皮瓣修复。
术后2例肌皮瓣远端4 cm坏死，清创后分别采用局部皮瓣及肋间后动脉穿支皮瓣修复创面。其余11例肌皮瓣完全存活，未发生动静脉危象。供区及受区伤口均一期愈合。所有患者均随访1至48个月（平均7.4个月），皮瓣色泽、质地良好。随访期间，1例因肿瘤复发再次行肿瘤切除，1例头皮血管肉瘤患者因不明原因胸腔出血死亡。其余患者未发现肿瘤复发。肌皮瓣覆盖稳定，感染得到控制。
携带部分背阔肌的下斜方肌肌皮瓣可作为修复伴有重要结构和器官外露及感染的难治性创面的替代选择。
