穿支桨状皮瓣移植术后早期联合放射疗法治疗胸壁瘢痕疙瘩

目的探讨胸廓内动脉穿支桨状皮瓣术后早期联合放射疗法治疗胸壁瘢痕疙瘩的手术要点及疗效。方法应用多普勒定位胸廓内动脉穿支位置及血管走行，根据胸壁瘢痕疙瘩大小设计螺旋桨状皮瓣，Ⅰ期修复创面，于术后24h及术后7d分别进行术区放射治疗。结果15例胸壁瘢痕疙瘩的患者中，1例出现静脉回流障碍，术后第3天清除部分皮瓣；其余皮瓣成活良好。术后随访所有患者8～24个月（平均12个月）。1例患者术后12个月皮瓣周围出现增生性瘢痕，其余无复发。结论我们的初步经验表明，胸廓内动脉穿支桨状皮瓣术后早期联合放射疗法治疗胸壁瘢痕疙瘩，手术的供区损伤小，复发率低，为较好的治疗方法。

Internal mammary artery perforator pedicled propeller flap combined with radiotherapy in treating chest wall keloid

Objective To investigate the outcome of internal mammary artery peribrator pedicled propeller flap combined with radiotherapy in treating chest wall keloid. Methods Carefully design the pedicled propellet flap according to the direction of different internal mammary artery perforators that are detected by handhold Doppler. Keloid resection and defect coverage were finished simultaneously and radiotherapy was given at the first and 7th day post operation. Results 15 patients suffered chest wall keloid received the combined therapy of internal mammary artery perforator pedicled propeller flap and radiotherapy. 1 patient suffered venous congestion and partial flap loss, and no patient suffered occurrence during 12 months follow up period on average （ 8 to 24 months）. Conclusion IMF perforator pedicled propeller flap combined with radiotherapy is a reliable and simple method in treating chest wall keloids.