【摘要】 目的:介绍利用超量扩张的背阔肌肌皮瓣修复女性胸部正中大面积挛缩瘢痕的手术方法,探讨其在应用方面的优势,为临床推广应用提供参考。方法:2009年-2014年,笔者使用本方法对16例烧伤后胸部正中大面积瘢痕的女性患者进行修复。使用800ml长方形扩张器扩张单侧背阔肌肌皮瓣,超量扩张2.5倍以上。扩张完成后,取出扩张器,以皮下隧道方式将扩张肌皮瓣转移至胸部,修复胸部正中瘢痕。供区一期缝合。结果:全部皮瓣均成活良好.平均皮瓣面积为28cm×22cm。扩张器扩张及手术过程中出现个别并发症,经积极处理,未对最终手术结果照成影响。术后患者功能外观改善明显,皮瓣颜色质地良好,回缩率低,效果稳定。供区均一期愈合,未见明显背部畸形或肩关节活动障碍。结论:单侧超量扩张的背阔肌肌皮瓣修复女性胸部正中大面积瘢痕临床效果好,组织量充足,供区隐蔽,是较为理想的修复方法。皮瓣血运稳定,手术操作相对简单,易于推广。更多还原

【Abstract】 Objective To introduce using unilateral excessive expanded latissimus dorsi myocutaneous flap for the repairment of large contracted scar in the central part of female chest.Evaluate this method and provide a reference for the clinical selection of appropriate treatment options. Methods From 2009 to 2014,16 female burn sequala patients underwent this two-staged operation for large contracted scar in the central part of chest reconstruction.A rectangle tissue expander(800ml) was inserted underneath unilateral latissimus dorsi in the first stage.After being expanded excessively over 2.5 times of the design capacity,the tissue expender was removed and the expanded myocutaneous flap was transferred to the central chest area via subcutaneous tunnel.The donor site was closed primarily. Results All flaps survived.The average size of the flaps was28cm×22cm.A few minor complications happened during the expanding and the post-operational period,which were controlled by positive treatments without affecting the final results.The appearance and function of the patients had improved significantly.The retraction rate of the flaps was low,the results were stable.The donor site healed without morbidity or obvious shoulder dysfunction.Conclusion Unilateral excessive expanded latissimus dorsi myocutaneous flap provides abundant tissue for large contracted scar repairment in the central part of female chest with donor site being well-concealed and preserved. This is a simple and safe method, which is worth recommended.更多还原