【摘要】 目的介绍岛状肌皮瓣在颈胸部难治性创面中的应用经验。方法1994年8月~2004年12月,收治98例颈胸部难治性创面患者,男42例,女56例;年龄21~68岁。病程3h~13个月。胸前部29例,颈部28例,项部18例,腋下或腋窝部15例,胸侧壁8例。创面范围6cm×4cm~20cm×15cm,其中感染创面27例,骨外露48例,心、肺等胸腔器官外露7例,深部重要血管、神经外露33例。根据创面所在部位、性质及致病因素的不同,采用不同的岛状肌皮瓣修复。其中岛状胸大肌肌皮瓣28例,岛状背阔肌肌皮瓣34例,岛状斜方肌肌皮瓣19例,岛状腹直肌肌皮瓣17例,皮瓣切取范围8cm×6cm~35cm×15cm。结果术后92例创面期愈合,肌皮瓣全部成活;6例肌皮瓣部分坏死,经对症处理后成活。83例获随访2周~5年,皮瓣色泽正常、质地良好,均获得满意功能和外形。结论修复颈项部创面可选用岛状胸大肌肌皮瓣、岛状背阔肌肌皮瓣、岛状斜方肌肌皮瓣;修复胸部创面可选用岛状背阔肌肌皮瓣、岛状腹直肌肌皮瓣;根据创面的具体情况选择适当的岛状肌皮瓣修复颈胸部难治性创面可获得满意功能和外形。更多还原

【Abstract】 Objective To introduce experiences in the application of island myocutaneous flap for refractory wound in cervico-thoracic region. Methods From August 1994 to December 2004, 98 cases of refractory wound in cervico-thoracic region were treated; there 42 males and 56 females, aging 21-68 years.The course of disease was 3 hours to 13 months. The locations were anterior pectorial region(29 cases), cervical part (28 cases), nuchal region (18 cases), subaxillary and axillary region (15 cases), and thoracic wall (8 cases). The defect area ranged from 6 cm×4 cm to 20 cm×15 cm. According to location, peculiarity and etiological factor of wound, various island myocutaneous flaps were selected: 28 pectoralis major island myocutaneous flaps, 34 latissimus dorsi island myocutaneous flaps, 19 trapizius island myocutaneous flaps and 17 rectus abdominis island myocutaneous flap. The sizes of the dissected flap ranged from 8 cm× 6 cm to 35 cm×15 cm. Results Of 98 patients, the wound healed by first intention and the flap survived completely in 92 and the flap necrosed partially in 6. The good function and cosmetic results were obtained without severe complication. Eighty-three cases were followed up from 2 weeks to 5 years. The flap obtained satisfactory appearance, good function and cosmetic results. Conclusion Repairing refractory wound in cervico-nuchal region may select pectoralis major island myocutaneous flap, latissimus dorsi island myocutaneous flap, and trapizius island myocutaneous flap; repairing refractory wound on thoracic region may select latissimus dorsi island myocutaneous flap and rectus abdominis island myocutaneous flap. According to specific condition of wound, using suitable island myocutaneous flap for refractory wound in cervico-thoracic region may obtain satisfactory functional and cosmetic results.更多还原