The Pedicled Latissimus Dorsi Flap Provides Effective Coverage for Large and Complex Soft Tissue Injuries Around the Elbow.
The Pedicled Latissimus Dorsi Flap Provides Effective Coverage for Large and Complex Soft Tissue Injuries Around the Elbow.
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DOI：
10.1177/1558944717725381
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发表时间：
2018-09-01
期刊：
影响因子：
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通讯作者：
Friedrich, Jeffrey B
中科院分区：
文献类型：
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作者：
Hacquebord, Jacques H;Hanel, Douglas P;Friedrich, Jeffrey B
背景技术背景：带蒂阔肌皮瓣已被证明可以有效覆盖手肘周围的伤口，平均大小为100至147 cm 2，但并发症发生率为20%至57%。我们认为，带蒂背阔肌皮瓣是一种有效和安全的技术，提供了可靠和持久的覆盖相当大的软组织缺损周围手肘和前臂近端。方法：进行回顾性分析，包括所有患者从港景医疗中心在1998年和2012年之间进行覆盖带蒂背阔肌皮瓣的手肘周围的缺陷。收集人口统计学信息、损伤机制、软组织缺损大小、并发症（轻微与严重）和手术时间。软组织缺损的大小，并发症，和成功的软组织覆盖率是主要的结局measurement.RESULTS：共有18例患者被确定与变量损伤机制。手肘周围的平均缺损尺寸为422 cm 2。3例患者皮瓣远端部分坏死，保守治疗。一名患者需要二次筋膜皮瓣，另一名患者因静脉充血需要转换为游离阔肌皮瓣。2例患者出院后失访。总的来说，88%（16例中的14例）的患者记录（>3个月随访）成功的软组织覆盖与单阶段带蒂背阔肌皮瓣。结论：带蒂背阔肌皮瓣是一个可靠的选择周围的大型和复杂的软组织损伤肘关节明显大于以前的报告。然而，前臂近端的覆盖仍然具有挑战性。
BACKGROUND: The pedicled latissimus flap has been shown to provide effective coverage of wounds around the elbow with an average size of 100 to 147 cm2 but with complication rates of 20% to 57%. We believe the pedicled latissimus dorsi flap is an effective and safe technique that provides reliable and durable coverage of considerably larger soft tissue defects around the elbow and proximal forearm.METHODS: A retrospective review was performed including all patients from Harborview Medical Center between 1998 and 2012 who underwent coverage with pedicled latissimus dorsi flap for defects around the elbow. Demographic information, injury mechanism, soft tissue defect size, complications (minor vs major), and time to surgery were collected. The size of the soft tissue defect, complications, and successful soft tissue coverage were the primary outcome measures.RESULTS: A total of 18 patients were identified with variable mechanisms of injury. Average defect size around the elbow was 422 cm2. Three patients had partial necrosis of the distal most aspect of the flap, which was treated conservatively. One patient required a secondary fasciocutaneous flap, and another required conversion to a free latissimus flap secondary to venous congestion. Two were lost to follow-up after discharge from the hospital. In all, 88% (14 of 16) of the patients had documented (>3-month follow-up) successful soft tissue coverage with single-stage pedicled latissimus dorsi flap.CONCLUSIONS: The pedicled latissimus dorsi flap is a reliable option for large and complex soft tissue injuries around the elbow significantly larger than previous reports. However, coverage of the proximal forearm remains challenging.