To investigate the effectiveness of latissimus dorsi Kiss flap for repairing composite tissue defects and functional reconstruction of upper arm.
Between March 2010 and November 2016, 12 cases of composite tissue defects of upper arm were repaired by latissimus dorsi Kiss flap with blood vessel and nerve bunch. There were 8 males and 4 females with a median age of 34 years (range, 21-50 years). The reason of injury included plowing mechanical injury in 4 cases, traffic accident injury in 5 cases, electrical injury in 2 cases, and resecting upper arm soft tissue sarcoma in 1 case. There were deltoid defect in 5 cases, triceps brachii and brachialis defect in 4 cases, and deltoid, triceps brachii, and brachialis damaged in varying degrees in 3 cases. The defect area ranged from 13 cm×7 cm to 20 cm×8 cm. Among them, there were 6 cases of fracture combined with partial bone exposure, one of them with bone defect. The disease duration was 3 hours to 6 months. The flap size ranged from 10 cm×6 cm to 15 cm×7 cm, and the donor sites were directly sutured.
Twelve flaps survived with primary healing of wounds. Ten patients were followed up 6-26 months (mean, 14 months). At last follow-up, the flaps were soft and the skin color was similar to the surrounding skin. No obvious scar was found at donor sites. The abduction range of motion of shoulder was 30-90°. The muscle strength of brachialis were all at grade 4 or above. The superficial sensation and tactile sensation recovered partialy (S 1 in 2 cases, S 2 in 6 cases, S 3 in 2 cases). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the shoulder joint function was excellent in 2 cases, good in 4 cases, and fair in 4 cases.
The design of the latissimus dorsi Kiss flaps are flexible, and the donor site can be directly sutured, with the nerves of the latissimus dorsi muscle can partialy reconstruct abduction function of upper arm. In general, the Kiss flap repairing upper arm defect can obtain satisfactory effectiveness.
探讨采用背阔肌 Kiss 皮瓣修复上臂复合组织缺损及功能重建的临床疗效。.
2010 年 3 月—2016 年 11 月,采用带神经血管束的背阔肌 Kiss 皮瓣修复 12 例上臂复合组织缺损。其中男 8 例,女 4 例;年龄 21~50 岁,中位年龄 34 岁。致伤原因:机械损伤 4 例,交通事故伤 5 例,电击伤 2 例,上臂软组织恶性肿瘤 1 例。合并三角肌缺损 5 例,肱三头肌及肱肌损伤 4 例,三角肌、肱三头肌及肱肌不同程度损伤 3 例。创面范围 13 cm×7 cm~20 cm×8 cm。合并骨折伴骨外露 6 例,其中 1 例合并骨缺损。病程 3 h~6 个月。皮瓣切取范围为 10 cm×6 cm~15 cm×7 cm;供区创面直接缝合。.
12 例皮瓣全部成活,供、受区创面均Ⅰ期愈合。10 例患者获随访,随访时间 6~26个月,平均 14 个月。末次随访时,移植皮瓣成活良好、质地柔软,颜色接近周围正常皮肤,供区仅见线性瘢痕;肩关节外展活动度达 30~90°,肱三头肌肌力均在 4 级及以上;浅感觉与触觉部分恢复,S 1 2 例,S 2 6 例,S 3 2 例。采用中华医学会手外科学会上肢部分功能评定试用标准评定肩关节功能,获优 2 例,良 4 例,可 4 例。.
背阔肌 Kiss 皮瓣设计灵活,供区可直接拉拢缝合,带神经支配的背阔肌可重建上肢部分外展功能,修复上臂复合组织缺损可获良好疗效。.