前锯肌肌筋膜瓣移植修复足背大面积软组织缺损的临床效果

doi:10.3877/cma.j.issn.1674-0785.2020.11.011

中华临床医师杂志(电子版) ›› 2020, Vol. 14 ›› Issue (11) : 906 -910. doi: 10.3877/cma.j.issn.1674-0785.2020.11.011

所属专题：文献；

临床研究

前锯肌肌筋膜瓣移植修复足背大面积软组织缺损的临床效果

张功林¹, 师富贵¹, 王行高¹, 何如祥¹, 胡军¹^,^†(

), 孙萍¹, 张俊峰¹, 赵来绪², 裴晓强², 汪新民²

^1. 730050　兰州，甘肃省兰州市兰州手足外科医院手外科
^2. 741300　甘肃武山，甘肃省武山县中医院骨科

收稿日期:2020-04-14 出版日期:2020-11-15
通信作者: 胡军
基金资助:
兰州市科学技术局项目(2018-4-60)

Repair of large area soft tissue defect on dorsal side of the foot by serratus anterior myofascial flap transplantation

Gonglin Zhang¹, Fugui Shi¹, Xinggao Wang¹, Ruxiang He¹, Jun Hu¹^,^†(), Ping Sun¹, Junfeng Zhang¹, Laixu Zhao², Xiaoqiang Pei², Xinmin Wang²

^1. Department of Hand Surgery, Lanzhou Hand and Foot Surgery Hospital, Lanzhou 730050
^2. Department of Orthopaedics, Wushan County Traditional Chinese Medical Hospital, Wushan 741300

Received:2020-04-14 Published:2020-11-15
Corresponding author: Jun Hu

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目的

总结前锯肌肌筋膜瓣移植修复足背大面积软组织缺损的临床应用效果。

方法

选择2015年1月至2019年1月，甘肃省兰州市兰州手足外科医院手外科应用前锯肌肌筋膜瓣移植修复足背大面积软组织缺损患者16例，其中，男11例，女5例；年龄24~50岁，平均（36.6±5.3）岁；软组织缺损范围为13 cm×8 cm~9 cm×6 cm。肌筋膜瓣切取连带肩胛下与旋肩胛血管，血管蒂近端呈“T”形，与受区胫前动脉两断端行端端吻合，肌筋膜瓣上用中厚网状游离植皮覆盖，供区创面直接缝合。

结果

术后肌筋膜瓣全部成活，随访1.2~4.5年，平均（3.4±?2.3）年，受区和供区外形较好，优9例，良6例，可1例，优良率为93.75%，取得了较满意的效果。

结论

前锯肌肌筋膜瓣移植手术操作安全、可靠，适于修复足背大面积软组织缺损，降低了对受区主要血管的损伤。

关键词: 足, 前锯肌, 肌筋膜瓣, 移植

Objective

To assess the clinical effects of repair of large area soft tissue defect on the dorsal side of the foot by serratus anterior myofascial flap transplantation.

Methods

Between January 2015 and January 2019, 16 patients with large area soft tissue defect on the dorsal side of the foot were treated by serratus anterior myofascial flap transplantation. There were 11 males and 5 females, aged from 24 to 50 years, mean of (36.6±5.3) years. The size of the soft tissue defect ranged from 13 cm×8 cm to 9 cm×6 cm. A serratus anterior myofascial flap was harvested with subscapular and circumflex scapular arteries forming a T-shaped vascular pedicle. The T-shaped vascular pedicle of the serratus anterior myofascial flap was anastomosed to the two ends of the anterior tibial artery at the recipient site by end-to-end anastomosis. Coverage of the myofascial flap was performed with a meshed split-thickness skin graft.

Results

All myofascial flaps survived completely. The patients were followed up for 1.2-4.5 years, with average of (3.4±2.3) years. A good contour was confirmed at the recipient and donor sites. The outcomes were excellent in nine patients, good in six, and fair in one, with an excellent or good rate of 3.75%. Satisfactory clinical results were achieved in this series.

Conclusion

This technique is safe, reliable, and particularly suitable for repairing large area soft tissue defect on the dorsal side of the foot and reducing the damage to main vessels of the recipient site.

Key words: Foot, Serratus anterior, Myofascial flap, Transplantation

图1 前锯肌肌筋膜瓣移植修复足背大面积软组织缺损患者情况　图a为术前左足背大面积软组织缺损伴肌腱外露创面，图b为术中清创后左足背创面情况（足外侧为已切取的前锯肌肌筋膜瓣），图c为术中用前锯肌肌筋膜瓣修复创面后外形，图d为在肌筋膜瓣表面行植皮修复3周后外形

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Repair of large area soft tissue defect on dorsal side of the foot by serratus anterior myofascial flap transplantation

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Repair of large area soft tissue defect on dorsal side of the foot by serratus anterior myofascial flap transplantation