目的 总结双侧游离股前外侧肌皮瓣联合移植修复肿瘤根治术后遗留大面积胸壁全层缺损的疗效和经验。 方法 自2011年1月至2018年12月使用双侧游离股前外侧肌皮瓣联合钛合金支架或骨水泥重建完成22例胸壁全层重建术，患者胸壁缺损面积为300~700 cm2（中位面积360 cm2），共设计切取44块肌皮瓣，其中皮肤面积（173.55±67.78）cm2，肌瓣面积（158.68±94.93）cm2。将皮瓣转移至胸壁缺损处，动脉行端-端吻合，根据可用受区动脉数量，采取外增压或内增压的方式重建2块肌皮瓣动脉血运。吻合静脉时，根据血管蒂及受区静脉数量与形态，采取不同的吻合策略。 结果 肌皮瓣全部存活，其中1块肌皮瓣远端部分坏死，清创后创面愈合。双侧大腿供区伤口全部顺利愈合，遗留线性瘢痕。术后随访6~36月，平均（18.27±8.62）月，所有患者未见局部复发，1例乳腺癌患者出现骨转移。重建胸壁质地良好，患者呼吸无明显异常，双下肢肌力、关节活动正常，患者满意度高。 结论 双侧游离股前外侧肌皮瓣联合移植能很好地覆盖胸壁缺损，根据不同的血管解剖特点切取肌皮瓣能最大程度保护供区功能，是行胸壁重建术的可靠方法。
Abstract
Objective To summarize the clinical results and experience of combined transplantation of bilateral free anterolateral thigh myocutaneous flaps to repair large full-thickness chest wall defects after radical resection of tumor. Methods From January 2011 to December 2018, 22 patients who needed full-thickness chest wall reconstruction by using using bilateral femoral anterolateral free myocutaneous flap combined with titanium alloy scaffold or bone cement were admitted to our unit. The area of chest wall defect ranged from 300 cm2 to 700 cm2 (median area was 360 cm2). A total of 44 myocutaneous flaps were designed and harvested, with skin area of (173.55±67.78) cm2 and muscle area of (158.68±94.93) cm2. The flaps were transferred to the chest wall defect, and the arteries were anastomosed in end-to-end manner. According to the number of available arteries in the recipient area, the arterial blood supply of the two musculocutaneous flaps was reconstructed by outer-supercharging or inner-supercharging. During venous anastomosis, different anastomosis strategies were adopted according to the number and pattern of different veins in the vascular pedicle and recipient area. Results All 44 myocutaneous flaps from 22 patients survived, while 1 myocutaneous flap had partial necrosis at the distal end, and the wound healed after debridement. All 44 wounds at the donor sites of bilateral thighs healed smoothly, leaving only linear scars. Patients were followed up for 6 to 36 months (18.27±8.62 months), and no local recurrence was found. Bone metastasis was found in one breast cancer patient. The texture of the reconstructed chest wall was good, the patient's breathing was normal, the muscle strength and joint activity of both lower limbs were not affected, and the patient's satisfaction was high. Conclusions The combined transplantation of bilateral free anterolateral thigh myocutaneous flaps can cover the chest wall defects well. At the same time, according to the different vascular anatomy, the myocutaneous flaps can protect the function of the donor site to the greatest extent, which is a reliable method for chest wall reconstruction.
关键词
股前外侧肌皮瓣 /
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旋股外侧动脉降支 /
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血管吻合 /
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胸壁修复
Key words
Anterolateral thigh myocutaneous flap /
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Descending branch of lateral circumflex femoral artery /
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Vascular anastomosis /
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Chest wall repair
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参考文献
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