探讨交腿桥式游离背阔肌肌皮瓣改进与临床应用效果。

自2012年1月至2018年1月，兰州手足外科医院手三科应用改进的交腿桥式游离背阔肌皮瓣修复小腿大面积软组织缺损12例，其中，男9例，女3例；年龄26~52岁，平均（36.6±5.3）岁；软组织缺损范围：（26 cm×9 cm）~（41 cm×10 cm）。肌皮瓣修复小腿创面后，胸背动、静脉与对侧腓动脉和大隐静脉相吻合，蒂表面行一期中厚网状游离植皮。

肌皮瓣全部成活，术后没有发生血管危象。有1例发生肌皮瓣远端小的表浅感染，经2周换药处理自然愈合。术后所有患者获1.5~4.5年随访，平均（3.8±5.3）年。受区外形较好，供区无明显功能丧失。按胫骨骨折疗效评定方法评估治疗效果，优7例，良4例，可1例，取得了较满意的效果。

改进的交腿桥式游离背阔肌皮瓣适用于修复小腿仅有1条主要血管的软组织缺损，减轻了对小腿供区的损伤。

To explore the improvement and clinical application of bridged free latissimus dorsi musculocutaneous flap.

Between January 2012 and January 2018, 12 patients with soft tissue defect of the leg were treated with bridged free latissimus dorsi musculocutaneous flap. There were nine males and three females. They ranged in age from 22 to 52 years, with a mean age of (36.6±5.3) years. The size of the soft-tissue defects of the leg ranged from 26 cm×9 cm to 41 cm×10 cm. After the soft tissue defect of the leg was repaired with the musculocutaneous flap, the thoracodorsal artery and vein were anastomosed to the contralateral fibular artery and the large saphenous vein. The vessel pedicles were repaired with a meshed split-thickness free skin graft.

All the musculocutaneous flaps survived completely. No clinical vascular deficiency was found on the musculocutaneous flap postoperatively. 1 case occurred small superficial infection at the distal part of the musculocutaneous flap, which spontaneously healed after 2 weeks of dressing changes. The follow-up period ranged from 1.5 to 4.5 years, with a mean of (3.8±5.3) years. A good contour was confirmed at the recipient area. There was no obvious morbidity at the donor site. The therapeutic effect was evaluated by the method for tibia fracture. The therapeutic effect was excellent in 7 cases, good in 4 cases, and fair in 1 case. Satisfactory clinical results were obtained in this series.

Bridged free latissimus dorsi musculocutaneous flap is suitable for the treatment of soft tissue defects of the leg with only one major blood vessel, which can reduce the damage to the donor site of the leg.