股前外侧-股外侧肌复合游离皮瓣联合筋膜补片重建胃管缺损：一例病例报告

文献信息

中文摘要

背景： 当一期修复失败且残余管壁变得脆弱时，胃管缺损的处理十分困难，尤其是在慢性感染和胸壁组织缺损的情况下。我们报告一例71岁男性，其胸骨后胃管在中位胸骨切开行冠状动脉旁路移植术时发生全层破裂。一期修复失败，导致慢性复发性裂开和胸骨伤口感染。对感染的胸骨和胸骨柄进行清创和部分切除后，遗留一个3×2 cm的非环形胃管缺损，并伴有相邻的胸骨前和纵隔死腔。我们切取了一块25×8 cm的股前外侧-股外侧肌复合游离皮瓣，其带有与股外侧肌相连的薄筋膜延伸部。将筋膜围绕整个缺损周缘缝合，作为无张力的主要补片。股外侧肌置于修复处上方，用于血管化加强和死腔填塞，而皮岛则提供外部覆盖和皮瓣监测。皮瓣被吻合至右侧颈横动脉和颈内静脉分支。未发生皮瓣相关并发症。4周时食管造影显示无漏；6周时实现完全经口进食。10个月时，吞咽症状仍处于食管切除术后术前基线水平，造影剂通过顺畅，电视透视检查未见功能性梗阻。本病例表明，针对局限性胃管缺损，采用成分特异性复合游离皮瓣重建是可行的。

英文摘要

Gastric conduit defects are difficult to manage when primary repair fails and the residual wall becomes friable, particularly in the setting of chronic infection and chest-wall tissue loss. We report a 71-year-old man with a retrosternal gastric conduit who sustained a full-thickness rupture during median sternotomy for coronary artery bypass grafting. Primary repair failed, resulting in chronic recurrent dehiscence and sternal wound infection. Debridement and partial resection of infected sternum and manubrium left a 3 × 2 cm noncircumferential conduit defect with adjacent presternal and mediastinal dead space. A 25 × 8 cm anterolateral thigh-vastus lateralis composite free flap was harvested with a thin fascial extension contiguous with the vastus lateralis muscle. The fascia was sutured around the entire defect perimeter as a tension-free primary patch. The vastus lateralis muscle was positioned over the repair for vascularized reinforcement and dead-space obliteration, while the skin paddle provided external coverage and flap monitoring. The flap was transferred to the right transverse cervical artery and branches of the internal jugular vein. No flap-related complications occurred. Esophagography at 4 weeks showed no leakage; full oral feeding was achieved by 6 weeks. At 10 months, swallowing symptoms remained at the preoperative post-esophagectomy baseline, with smooth contrast passage and no functional obstruction on videofluoroscopy. This case shows the feasibility of component-specific composite free-flap reconstruction for a limited gastric conduit defect.