Lucas A E, Snow N, Tobin G R, Flint L M
Ann Thorac Surg. 1982 Jun;33(6):619-23. doi: 10.1016/s0003-4975(10)60823-5.
A 16-year-old boy sustained vehicular blunt trauma with delayed esophageal rupture that resulted in empyema and an esophagopleurocutaneous fistula. Diverting esophagostomy, gastrotomy, and transpyloric jejunostomy were performed, and these procedures permitted satisfactory nutritional support of the patient. Staged direct closure of the esophagus buttressed by a rhomboid muscle flap preserved normal esophageal function. Both clinical application and cadaver dissections have demonstrated that the rhomboid flap has an excellent blood supply and that it can be used to repair lesions on either side in the upper half of the esophagus. Because this flap is extrathoracic, it is not usually distorted by intrathoracic sepsis or previous thoracic incisions. The rhomboid major muscle flap is an excellent alternative to conventional autogenous grafts for esophageal repair.
一名16岁男孩遭受车辆钝性创伤，导致延迟性食管破裂，进而引发脓胸和食管胸膜皮肤瘘。实施了转流性食管造口术、胃切开术和经幽门空肠造口术，这些操作使患者获得了满意的营养支持。采用菱形肌瓣支撑分期直接缝合食管，保留了正常的食管功能。临床应用和尸体解剖均表明，菱形肌瓣血供良好，可用于修复食管上半段任一侧的病变。由于该肌瓣位于胸外，通常不会因胸腔内感染或既往胸部手术切口而变形。对于食管修复，菱形大肌瓣是传统自体移植物的极佳替代方案。
