Brown D M, Sicard G A, Flye M W, Khouri R K
Department of Surgery, Washington University School of Medicine, St. Louis, Mo. 63110.
Surgery. 1993 Jul;114(1):112-6.
Large full-thickness abdominal wall defects present a difficult reconstructive problem. Synthetic mesh has significant drawbacks and should be used only as a temporizing measure. Ideally abdominal wall defects should be resurfaced with well-vascularized autologous fascia and skin. A variety of myofascial, myocutaneous, and myofasciocutaneous flaps have been described. This report describes two cases of near-total abdominal wall reconstruction using bilateral rectus femoris myocutaneous flaps with fasciocutaneous extensions of superficial thigh fascia and skin. In both cases the rectus femoris flaps and fascial extensions healed, and the patients went on to full recovery. In one patient the skin over the fascial extension did not survive and had to be debrided and the underlying vascularized fascia resurfaced with a skin graft. The extended rectus femoris flap is a reliable and versatile flap that leaves negligible functional deficits. The fascial extensions are reliable and well perfused and should be included in the reconstruction of larger abdominal wall defects. The skin overlying the fascial extensions is less reliable, and selective use is recommended.
大面积全层腹壁缺损带来了困难的重建问题。合成网片有显著缺点，仅应用作临时措施。理想情况下，腹壁缺损应用血运良好的自体筋膜和皮肤进行覆盖。已经描述了多种肌筋膜瓣、肌皮瓣和肌筋膜皮瓣。本报告描述了两例使用双侧股直肌肌皮瓣并带有大腿浅筋膜和皮肤的筋膜皮瓣延伸部分进行近全腹壁重建的病例。在这两例中，股直肌瓣和筋膜延伸部分均愈合，患者得以完全康复。在一例患者中，筋膜延伸部分上方的皮肤未能存活，必须进行清创，并用皮肤移植覆盖下方有血运的筋膜。延长股直肌瓣是一种可靠且多功能的皮瓣，造成的功能缺陷可忽略不计。筋膜延伸部分可靠且血运良好，应纳入较大腹壁缺损的重建中。筋膜延伸部分上方的皮肤可靠性较差，建议选择性使用。
