大腿筋膜張筋皮弁による体幹・四肢帯再建の経験

Experience with Tensor Fascia Lata Flap in Reconstruction of the Trunk Wall and Limb Girdle

　抄録：大腿筋膜張筋皮弁（TFL）にて体幹・四肢帯を再建した15例の治療成績について検討した．疾患は悪性腫瘍12例，感染症3例で手術時年齢は平均55歳，術後経過観察期間は平均43カ月であった．再建部位は腹壁4例，胸壁・殿部各3例，肩・鼡径部各2例，骨盤底1例で，腹壁2例では両側TFLを使用した．有茎島状皮弁9例，遊離皮弁8例で1例を除いて皮弁付であり，その大きさは長径が平均23cm（15～30cm），短径10cm（6～15cm）であった．術後血行障害はなく皮弁は全例生着したが，2例に先端部の辺縁壊死を認めた．腹壁再建1例にヘルニアを合併したが，その他は体幹の支持性に問題はなかった．また，肩再建2例もほぼ正常な機能を回復した．皮弁採取部は10例では直接閉鎖したが，5例では遊離植皮を行った．このようにTFLは大きな皮弁が採取でき強靱な筋膜構造を有することから，悪性腫瘍の切除後など各種の再建外科に有用であり，選択肢の1つに加えられるべきである．

　We reviewed our experience with the use of 17 tensor fascia lata flaps for reconstrustion of the trunk wall and limb girdle in 15 patients. The mean age of the patients was 55 years (range, 31-78), and the mean follow-up period was 43 months (range, 1-120). An extensive defect was created after resection of a malignant tumor in 12 of the patients and after resection of infected tissues in the other 3 patients. Nine pedicle island flaps and 8 free flaps were used, and all flaps except one included a skin flap whose average size was 23cm×10cm. There were no vascular complications. All of the flaps survived, and wound healing was uneventful. Marginal necrosis occurred in the distal portion of the flap in 2 patients, and minor surgery was performed to promote wound healing. Function of the thoracic wall, abdominal wall, and pelvic floor after reconstruction was excellent, except in one patient. Shoulder function fully restored by reconstruction of the deltoid and the trapezius muscles. The donor site was closed directly in 10 patients, but the other five patients required a free skin graft. Thus, tensor fascia lata flap are extremely useful in reconstruction of the trunk wall and limb girdle, especially after oncological resection, because they provide a large skin paddle and strong fascial structure.