Chang L D, Goldberg N H, Chang B, Spence R
Division of Plastic and Reconstructive Surgery, University of Maryland, Baltimore.
Ann Plast Surg. 1994 May;32(5):496-502. doi: 10.1097/00000637-199405000-00010.
Upper extremity reconstruction is very challenging due to the unavailability of expendable local muscles. A review of the literature reveals that the latissimus dorsi muscle has been used for functional restoration of elbow extension and flexion as well as soft-tissue coverage of upper arm and shoulder defects. In addition, the latissimus dorsi muscle has been used for forearm reconstruction. Although we have been unable to find any reports of the use of the latissimus dorsi muscle for pure coverage of complex elbow wounds, we have successfully used the latissimus dorsi transposition flap to cover complex elbow defects in a one-staged procedure for patients. In 3 of 4 patients, the latissimus dorsi transposition flap was the first choice. In the other patient, the latissimus dorsi flap was successfully used as an alternative choice for coverage of an open, comminuted elbow fracture after a failed rectus abdominis free tissue transfer. A technique is described for coverage of complex elbow defects by transferring a latissimus dorsi muscle on its vascular pedicle with or without an overlying skin island. This procedure is safe, one-staged, and results in minimal donor morbidity. The latissimus dorsi transposition flap provides reliable coverage of complex elbow defects and should be considered the flap of choice for coverage of the elbow.
由于无法利用可牺牲的局部肌肉，上肢重建极具挑战性。文献回顾显示，背阔肌已被用于恢复肘部伸展和屈曲功能，以及覆盖上臂和肩部缺损的软组织。此外，背阔肌还被用于前臂重建。虽然我们未能找到关于使用背阔肌单纯覆盖复杂肘部伤口的任何报道，但我们已成功地采用背阔肌移位皮瓣在一期手术中为患者覆盖复杂的肘部缺损。在4例患者中有3例，背阔肌移位皮瓣是首选。在另一例患者中，在腹直肌游离组织移植失败后，背阔肌皮瓣成功地作为覆盖开放性粉碎性肘部骨折的替代选择。本文描述了一种通过转移带或不带覆盖皮岛的带血管蒂背阔肌来覆盖复杂肘部缺损的技术。该手术安全、一期完成，且供区并发症极少。背阔肌移位皮瓣可为复杂肘部缺损提供可靠的覆盖，应被视为覆盖肘部的首选皮瓣。
