Effect of pedicled thoracodorsal artery perforator flap on the repair of moderate to severe axillary scar contracture deformity
-
摘要: 目的 探讨带蒂胸背动脉穿支(TDAP)皮瓣整复腋窝中重度瘢痕挛缩畸形的效果。 方法 2012年1月—2017年1月,中南大学湘雅二医院收治29例腋窝中重度瘢痕挛缩畸形患者,其中男18例、女11例,年龄为14~42岁,双侧腋窝瘢痕挛缩畸形3例、单侧腋窝瘢痕挛缩畸形26例。完善术前相关检查,控制基础疾病后,在气管插管麻醉下行腋窝瘢痕切除松解,瘢痕切除松解后创面面积为7.5 cm×5.0 cm~21.0 cm×8.5 cm。采用带蒂TDAP皮瓣进行整复,皮瓣转移前根据需要进行适当修薄,皮瓣面积为9.0 cm×6.0 cm~22.0 cm×10.0 cm。供瓣区直接拉拢缝合。观察皮瓣修薄情况,术后和随访时皮瓣成活情况及随访时肩关节功能情况。 结果 本组患者共切取32个带蒂TDAP皮瓣,其中14个皮瓣未修薄,厚度为9.0~15.0 mm,平均13.6 mm;18个皮瓣进行修薄处理,修薄后皮瓣厚度为5.0~8.0 mm,平均7.5 mm。3例患者术后72 h内3个皮瓣远端局部出现小面积变黑和坏死,其中2个为修薄皮瓣、1个为未修薄皮瓣,经高压氧、换药等治疗后愈合。1个皮瓣术后8 h因蒂部受压出现静脉淤血,当压力解除后皮瓣颜色明显好转,其余皮瓣存活良好。所有患者均获随访,时间9~36个月,平均18个月,所有皮瓣均存活良好,皮瓣颜色与受区基本一致,未出现明显挛缩;患者肩关节运动功能较术前明显改善,肩关节外展角度90.0~145.0°,平均130.0°。 结论 带蒂TDAP皮瓣是整复腋窝中重度瘢痕挛缩畸形较佳的选择,如果能根据腋窝缺损情况进行适当修薄将会获得更加理想的效果。Abstract: Objective To investigate the effect of pedicled thoracodorsal artery perforator (TDAP) flap on the repair of axillary moderate to severe scar contracture deformity. Methods From January 2012 to January 2017, 29 patients with axillary moderate to severe scar contracture deformity were admitted to the the Second Xiangya Hospital of Central South University, including 18 females and 11 males, aged 14-42 years. There were 3 patients with cicatricial contracture deformity of bilateral axillas and 26 patients with cicatricial contracture deformity of unilateral axilla. After relevant preoperative examinations were completed and basic diseases were controlled, axillary scar was removed or released under the anesthesia of endotracheal intubation. The areas of wounds ranged from 7.5 cm×5.0 cm to 21.0 cm×8.5 cm after the operation. The pedicled TDAP flaps were used to repair the defects, which were thinned based on demand of the recipient sites before being transferred. The areas of flaps ranged from 9.0 cm×6.0 cm to 22.0 cm×10.0 cm. The donor sites were sutured directly. The status of thinned flaps, the survival of flaps after the operation and during follow-up, and the shoulder joint function during follow-up were observed. Results Thirty-two pedicled TDAP flaps were harvested for repairing the defects. Among them, 14 flaps were transferred directly without thinning and the thickness of the flaps ranged from 9.0 mm to 15.0 mm, with average thickness of 13.6 mm.While the other 18 flaps were thinned, and the thickness of the thinned flaps ranged from 5.0 mm to 8.0 mm, with average thickness of 7.5 mm. The distal parts of 3 flaps in 3 patients showed small size of blackening or necrosis within 72 hours after the operation, and 2 of them were thinned and the other one was not. Finally, the 3 flaps were healed after hyperbaric oxygen therapy, dressing change, or other treatments. One flap occurred vein congestion 8 hours after the operation caused by pressure on the pedicle, and the color of the flap turned back to normal after the pressure was relieved. The rest of the flaps survived well. All the patients were followed up for 9 to 36 months, with an average of 18 months. All the flaps survived well, the color of the flaps was nearly the same as the recipient sites, and none of the flaps developed obvious contraction. The shoulder joint function of all patients was significantly improved compared with that before operation, with abduction angles of shoulder joints ranged from 90.0-145.0°, with an average of 130.0°. Conclusions Pedicled TDAP flap is an relatively ideal choice for the repair of moderate to severe axillary scar contracture deformity, and better results will be achieved if the flaps are thinned to a appropriate thickness according to the condition of axillary defects.
-
Key words:
- Surgical flaps /
- Cicatrix /
- Axilla /
- Thoracodorsal artery perforator flap /
- Repair
点击查看大图
计量
- 文章访问数: 76
- HTML全文浏览量: 11
- PDF下载量: 11
- 被引次数: 0