血管变异型前臂背侧皮瓣修复手部皮肤软组织缺损

目的 探讨骨间后动脉血管变异时前臂背侧皮瓣的切取方法.方法 以骨间后动脉为蒂逆行岛状皮瓣转移修复手部皮肤软组织缺损时,遇到血管变异共9例,采取以骨间后动脉桡侧支为蒂切取逆行岛状前臂背侧皮瓣、以骨间后动脉近端为蒂切取游离骨间后动脉皮瓣、以骨间后动脉穿支为蒂切取游离前臂背侧穿支皮瓣等方法,进行皮瓣转移或移植修复手部创面.结果 9例皮瓣中有8例顺利存活;1例术后2 d皮瓣远端出现肿胀、青紫、小水泡,及时对症处理,5 d后部分皮缘形成干痂,皮瓣颜色恢复正常,脱痂后存活.9例随访3个月至2年,皮瓣质地柔软,弹性好,外形满意.结论 以桡骨间后动脉侧支为蒂的前臂背侧皮瓣逆行转移,以骨间后动脉近端或骨间后动脉穿支为蒂的前臂背侧皮瓣游离移植修复手部创面,是解决骨间后动脉血管变异较理想的方法.

Dorsal forearm flaps with vascular variation for repair of soft tissue defect on dorsum of the hand

Objective To investigate the methods to harvest dorsal forearm flaps when there exists variations of the dorsal interosseous artery. Methods Variations of the dorsal interosseous artery were encountered in 9 cases during retrogredo transfer of dorsal forearm island flap pedicled on the dorsal interosseous artery to cover soft tissue defect on dorsum of the hand. Several alternative methods were used to complete the flap harvest and transfer, including reverse island dorsal forearm flap pedicled on radial branch of the dorsal interosseous artery, free posterior interosseous reverse flow flap with proximal dorsal interosseous artery as the pedicle, free dorsal forearm perforator flap based on the perforators of the dorsal interosseous artery. Results Eight of the 9 flaps survived. Swelling, cyanosis and blister in the distal portion of the flap occurred in 1 case 2days after the operation. This was treated accordingly. Five days later,eschar formed at the edge of the flap and the flap returned to normal color. Eventually this flap survived after the eschar peeled off. The 9 eases were followed up for 3 months to 2 years. The flaps were soft and elastic. The appearance was satisfactory.Conclusion Reverse island dorsal forearm flap pedieled on radial branch of the dorsal interosseous artery, free posterior interosseous reverse flow flap with proximal dorsal interosseous artery as the pedicle and free dorsal forearm perforator flap based on the perforators of the dorsal interosseous artery are good altematives to deal with dorsal interosseous artery variations during dorsal forearm flap transfer.