摘要目的 观察并评价改良肩胛皮瓣修复难愈性创面的临床效果. 方法 2008年2月-2013年2月,笔者单位收治10例交通伤、烧伤、糖尿病足所致面部及四肢软组织缺损伴骨、肌腱外露难愈性创面患者,创面面积11 cm×7 cm～16 cm×15 cm.采用面积为12 cm×8 cm～ 17 cm×16 cm的改良肩胛皮瓣修复创面,其中6例直接移植、4例桥接移植.操作中将皮瓣血管游离至肩胛下血管及其胸背分支,与旋肩胛血管形成T形血管蒂,与受区血管行两侧端端吻合.供区移植自体中厚皮或直接缝合. 结果 术后9例皮瓣成活,创面愈合;1例皮瓣远端出现少许水疱、渗液,换药2周后创面愈合.桥式皮瓣断蒂时间为术后4～6周.随访6～12个月,2例皮瓣稍臃肿,其余8例外形质地较佳,活动功能恢复;背部供区未见明显瘢痕增生,肩关节功能正常,供区知名血管搏动正常. 结论 改良肩胛皮瓣游离移植修复难愈性创面后,其外形、质地、功能恢复达预期效果,适合在临床推广应用.

abstractsObjective To observe and evaluate the clinical effects of improved scapula flap in repairing refractory wound.Methods Ten patients,with refractory wounds (ranging from 11 cm × 7 cm to 16 cm × 15 cm) on face and extremities combined with bone and tendon exposure as a result of traffic injury,burns,or diabetic feet,were hospitalized from February 2008 to February 2013.The wounds were repaired with improved scapula flap ranging from 12 cm ×8 cm to 17 cm × 16 cm.Six of them were grafted directly; 4 of them were grafted with bridging.The vessel of flap was freed to the subscapular vessel and its thoracodorsal branch,forming the T-shape vessel pedicle with circumflex scapular vessel,and the vessels on two sides of vessel pedicle were anastomosed with vessels in recipient area.The donor sites were sutured directly or covered with autologous medium-thickness skin graft.Results Nine flaps survived after surgery; the wounds were healed.Few blisters and exudation were observed at the distal end of one flap,which was cured after dressing change for 2 weeks.The pedicles of the bridge-like flap were divided 4-6 weeks after surgery.All the patients were followed up for6 to 12 months.Slight swelling was observed in 2 flaps.The appearance and texture of the other 8 flaps were good,and the function of the recipient area recovered.No obvious hypertrophic scar was observed in donor site on the back,with normal function of shoulder joint and pulsation of named vessels.Conclusions Repairing refractory wounds with improved scapula flaps can result in good appearance,texture,and satisfactory function,which should be popularized in clinic.