Background: 

The free split latissimus dorsi flap for lower-extremity reconstruction has some advantages over the traditional latissimus dorsi flap. The flap is harvested with the patient in the supine position and is associated with minimal morbidity as the function of the remaining latissimus dorsi muscle is preserved through the posterior division of the thoracodorsal nerve.

Methods: 

A consecutive single-surgeon 5-year series of free split latissimus dorsi muscle flaps for lower-extremity reconstruction (n = 42) was evaluated. Donor site morbidity was evaluated through assessment of the strength of the remaining latissimus dorsi at least 1 month after surgery. Shoulder function was evaluated postoperatively using the Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score, and Shoulder Pain and Disability Index (SPADI).

Results: 

The mean age of the 42 patients was 40.7 years. The mean length and width of the flaps were 17.9 cm and 8.6 cm. The majority (71%) of the wounds were due to acute trauma. Of the 42 flap procedures performed, 95% (40) were successful. Assessment of remaining latissimus dorsi strength at least 1 month postoperatively, during 3 activities, showed a Medical Research Council (MRC) grade of 5 in all patients. The mean and median scores were 6.4 and 0 according to the DASH, 6.0/6.4 and 0/0 on the SPADI pain/disability scales, and 90.7 and 100 on the ASES.

Conclusions: 

The free split latissimus dorsi flap is a large reliable muscle flap with negligible donor site morbidity that is particularly advantageous for lower-extremity resurfacing following trauma.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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保留功能的无裂背阔肌皮瓣用于下肢重建：连续五年单手术系列。

背景： 

与传统的背阔肌皮瓣相比，用于下肢重建的自由分割背阔肌皮瓣具有一些优势。当患者仰卧位时收起皮瓣，由于通过胸背神经的后部保留了剩余的背阔肌的功能，因此发病率极低。

方法： 

评估了连续5年免费手术的下肢重建阔腿背阔肌皮瓣的单次手术系列（n = 42）。至少在术后1个月通过评估剩余背阔肌的强度来评估供体部位的发病率。术后使用手臂，肩膀和手部残疾（DASH）评分，美国肩膀和肘部外科医生（ASES）评分以及肩膀疼痛和残疾指数（SPADI）评估肩膀功能。

结果： 

42例患者的平均年龄为40.7岁。皮瓣的平均长度和宽度分别为17.9厘米和8.6厘米。伤口的大部分（71％）是由于急性创伤引起的。在执行的42次皮瓣手术中，有95％（40）成功。在3次活动中，至少在术后1个月评估了背阔肌的剩余力量，发现所有患者的医学研究委员会（MRC）等级均为5。根据DASH的平均值和中位数分别为6.4和0，在SPADI疼痛/残疾量表上分别为6.0 / 6.4和0/0，在ASES上分别为90.7和100。

结论： 

游离背阔肌皮瓣是一个大型可靠的肌肉皮瓣，供体部位发病率可忽略不计，这对于创伤后下肢重塑特别有利。

证据级别： 

治疗级别IV。有关证据水平的完整说明，请参见《作者说明》。