Modified Free Latissimus Dorsi-Thoracodorsal Artery Perforator Flap for Resurfacing Extensive Soft Tissue Defect-A Case Report

改良的游離擴背肌合併胸背動脈穿通支皮瓣用於廣泛性軟組織缺損－一個小兒病例報告

林政達(Cheng-Ta Lin) ； 陳理維(Lee-Wei Chen)

《中華民國整形外科醫學會雜誌》 16卷2期 (2007/06) Pp. 170-176

https://doi.org/10.7096/JPSA.200706.0170

摘要

胸背動脈穿通支皮瓣對於多種不同軟組織重建是相當有用的。對於廣泛性軟組織缺損來說，有學者提出合併式（或嵌合式）擴背肌－胸背動脈穿通支皮瓣來作重建。我們利用這個觀念來重建一個小兒病患的廣泛性軟組織缺損。
病人是一位七歲的男孩，患有右側足部以及腳踝廣泛環繞性軟組織缺損。我們於術前使用彩色都卜勒超音波對病患的胸背動脈及其皮膚穿通支走向作定位分析，只有偵測到一支很小的（直徑約零點三毫米）穿通支由胸背動脈下行支所發出，將穿通支從周圍的組織解剖開來是危險的。為了保護脆弱的穿通支，我們保留穿通支周圍的深筋膜層完整不分開，並且不作肌肉內解剖。皮瓣和肌肉能以此近端相連處為軸轉動，也因此可以修補廣泛性缺損。
術前彩色都卜勒超音波可定位皮膚穿通支的確實位置，測量其大小，以及血流流速。它確實可幫助皮瓣的取得，而且避免對穿通支的傷害。

並列摘要

The thoracodorsal artery perforator flap is a versatile flap for resurfacing of various soft tissue defects. For resurfacing extensive defects, authors advocated combined (or chimeric) latissimus dorsi-thoracodorsal artery perforator flaps.
The patient is a 7 years old boy who sustained an extensive circumferential soft tissue defect at his right foot and ankle. We used color Doppler songraphy to evaluate the course of thoracodorsal artery and its skin perforators preoperatively. Only a tiny (about 0.3 mm in diameter) skin perforator derived from the descending branch of thoracodorsal artery was detected. To protect the fragile perforator, the deep fascial plane around the perforator was not dissected, and intramuscular dissection for releasing the perforator was not done. The skin paddle was rotated over the proximal attachment between the skin flap and the muscle bulk, which contained the skin perforator. Accordingly, the flap could resurface an extensive soft tissue defect.
Preoperative color Doppler sonogrphy can identify the exact location, estimate the size, and measure the blood flow rate of a skin perforator. It does facilitate the flap elevation, and prevent injury to skin perforators.

並列關鍵字

thoracodorsal artery ； perforator flap ； color Doppler