前臂尺侧游离皮瓣在舌再造中的应用

目的：探讨用前臂尺侧游离皮瓣修复舌缺损的效果及切取皮瓣后对手功能的影响,方法：对15例舌癌术后用前臂尺侧游离皮瓣即刻修复舌缺损,术后观察成功率,舌的外形,活动度及粘膜化情况,对手术前后左右手小指及无名指的两点触觉进行比较。结果：15例用前臂尺侧游离皮瓣修复舌缺损的皮瓣全部成活,舌外形,活动度及粘膜化均满意,术前和术后双手小指和无名指二点触觉及痛觉未见明显差异,而10例桡侧皮瓣的患者中有3例半年内拇指和食指有不同程度的感觉迟钝,结论．：前臂尺侧游离皮瓣由于位置较桡侧隐蔽,质地更细腻,切取后对拇指及食指掌侧的感觉功能无影响,该皮瓣不失为舌缺损修复再造的首选皮瓣之一。     

前臂游离皮瓣功能性修复颌面部缺损的临床体会

目的：探讨个体化设计前臂皮瓣修复领面部缺损,以期达到恢复其解剖形态和生理功能的目的。方法：选择舌癌、颊癌、口底癌患者20例,设计前臂皮瓣时,一是根据缺损大小、形状设计其皮肤外形,二是根据桡动脉和头静脉走行,设计皮下筋膜层外形,包括桡动脉和头静脉在内,大于皮肤范围。术后半个月、3个月、6个月评价修复器官的解剖形态、黏膜化程度、发音清晰度、运动及饮食类型等诸方面生理功能。结果：20例皮瓣全部获得成功,术后半个月和3个月有不同程度的皮瓣外形臃肿,6个月后．修复器官解剖形态无臃肿和牵拉,发音较清晰,感觉功能也有不同程度的恢复,大部分患者（18／20）进普食,少部分（2／20）为软食。结论：皮肤和筋膜下设计前臂皮瓣修复颌面部缺损,可以较好恢复颌面部器官的解剖形态和生理功能。     

前臂尺侧游离皮瓣在口腔颌面外科的应用——附30例临床报道

目的详细阐明前臂尺侧游离皮瓣的应用解剖、制做技术及在口腔颌面外科的应用。方法对３０例前臂尺侧游离皮瓣修复口腔颌面部缺损的病例，进行了临床回顾性分析。结果前臂尺侧游离皮瓣具有较薄、柔软、弹性好且与面部的色泽相近的优点。它血管蒂长、口径较粗，适合与口腔颌面部的血管吻合。与前臂桡侧游离皮瓣相比，它的供区疤痕相对隐蔽，本组成功率为９０％。主要不足是损失了前臂一条主要供应血管一尺动脉。结论当某种原因，前臂桡侧游离皮瓣不能切取，如桡动脉阻塞，近期曾行桡部静脉穿刺或经该静脉行化疗，这时前臂尺侧游离皮瓣不失为口腔颌面部软组织缺损游离修复的最佳选择。     

应用折叠的双皮岛游离前臂皮瓣修复口腔颌面部缺损

目的探讨折叠的双皮岛游离前臂皮瓣在口腔颌面部缺损修复中的可靠性和应用价值。方法应用折叠的双皮岛游离前臂移植修复口腔颌面部缺损的病例33例，分析缺损的部位、范围、所采用组织瓣的设计、受区血管、血管吻合方式和技术、皮瓣成活情况及术后并发症的发生情况，并分析有可能影响皮瓣戍活的各种因素。结果33例患者中，10例为颊部的洞穿缺损，15例为上颌骨切除术后的缺损，6例为腭部洞穿缺损，2例为先天性腭裂术后巨大腭瘘，全部患者的33块前臂皮瓣均成活，无一例发生全部或部分坏死，全部皮岛均获得成活并完成修复目的。皮瓣术后血管危象的发生率为3．0％，抢救成功率为100％。结论折叠的双皮岛游离前臂皮瓣在口腔颌面部洞穿缺损的修复中具有很大的灵活性，其血供可靠并且制备简便，值得进一步推广和应用。     

联合应用游离腓骨瓣和前臂皮瓣修复口腔下颌骨复合缺损

目的 :分析联合应用游离腓骨瓣和前臂皮瓣在口腔下颌骨复合缺损修复中的应用价值。方法 :对2 0 0 0 0 3～ 2 0 0 2 0 1期间完成的 2 3例联合应用游离腓骨瓣和前臂瓣行口腔下颌骨缺损修复的病例作回顾性研究 ,分析缺损的类型、受区血管、游离瓣成活情况及术后并发症的发生情况 ,并分析有可能影响游离瓣成活的各种因素。结果 :2 3例患者中男性 17例 ,女性 6例 ,年龄 3 1～ 72岁 ,平均 5 2 .9岁 ,所采用的游离腓骨复合瓣中 ,腓骨长度 6～ 15cm(平均 10 .6cm) ,皮岛最大面积 12cm× 5cm ,最小 5cm× 3cm(平均 8.4cm×3 .6cm) ,腓骨的截骨次数为 0～ 3次 (平均 1.7次 ) ,所采用前臂皮瓣最大面积 10cm× 8cm ,最小 6cm× 5cm ,平均 7.8cm× 6.4cm。 2 3例患者的 46块游离瓣全部获得成活 ,受区和供区总的并发症发生率为3 0 .4% ,但并发症均不严重 ,没有造成严重的后果。结论 :游离腓骨瓣和前臂皮瓣联合应用在大型口腔下颌骨复合缺损的修复中具有较大的灵活性 ,安全可靠 ,并能较好地恢复患者的外形和功能 ,提高了患者的生存质量     

Dealing with vascular anomalies during radial forearm free flap harvest: report of two cases and review of the literature

Radial forearm free flap reconstruction for head and neck cancer is very common, and it is widely considered a workhorse flap. Although this flap has a relatively reliable anatomy, surgeons need to be aware of possible anatomical variations and how to deal with them. This paper presents the cases of two patients who underwent oral reconstruction, in whom anomalies of the radial artery were identified while raising a radial forearm free flap. Case 1 demonstrates the dominant branch of the radial artery joining the common interosseous artery approximately 9 cm from the first wrist crease. Case 2 demonstrates abnormal distal branching of the radial artery approximately 4 cm from the first wrist crease. Reconstruction with the flap was successful in both cases. A literature review of reported anomalies of the radial artery is presented, and how to deal with such vascular anomalies is discussed.     

Hand perfusion following radial or ulnar forearm free flap harvest for oral cavity reconstruction: A prospective study

The radial forearm free flap (RFFF) and ulnar forearm free flap (UFFF) are used in head and neck reconstruction because they provide a thin and pliable skin paddle as well as a long vascular pedicle. However, in spite of several studies showing the safety of the UFFF, the RFFF is more popular among reconstructive surgeons based on concerns about hand ischaemia. A prospective study was designed in which 10 UFFF and 11 RFFF surgeries were performed in 20 patients undergoing oral cavity reconstruction between January 2017 and July 2018. Hand vascular parameters were evaluated preoperatively and postoperatively using Doppler ultrasound and plethysmography. The preoperative and postoperative diameters of the radial and ulnar arteries, and the flow velocities through the remainder of the forearm artery were measured preoperatively and at 3 months postoperative. Additionally, a comparison was performed between the preoperative and postoperative fingertip perfusion values according to impedance plethysmography. The preoperative mean diameter of the radial artery (2.89 ± 0.47 mm) was significantly greater than that of the ulnar artery (2.35 ± 0.48 mm) at the level of the wrist; however, 3 months after the surgery, the mean diameters of the two arteries did not differ significantly. There were no differences in digital perfusion when a UFFF was used compared with an RFFF.     

Bipaddled submental artery flap

Oral cancer is a major public health problem in India. Most patients present with locally advanced disease requiring complex resection and reconstruction strategies. Costs, operating time and availability of expertise are major issues that influence efficient health delivery, especially in developing countries such as India. Technically simple and widely reproducible techniques may be used successfully where applicable, to overcome these issues. The submental artery flap is a well described and acceptable alternative to the radial artery forearm free flap in oral cavity reconstruction. Researchers have demonstrated its technical ease of performance and reproducibility amongst trainees. Here the authors describe the bipaddled submental artery flap, a modification of the standard flap, which can be used to provide lining as well as skin cover for a full thickness cheek defect. Two skin paddles are fashioned taking advantage of the vascular anatomy of the submental vessels.     

驱血和非驱血状态下制备游离前臂瓣对皮瓣血压及出血的影响

目的:比较驱血和非驱血2种状态下制备前臂游离皮瓣对皮瓣血压及出血的影响。方法:在桡动脉和头静脉的远心端插入压力传感器,观察前臂驱血后安放电子止血带和未驱血直接安放电子止血带2种状态下皮瓣动静脉系统的血压变化及取瓣过程中的出血量。结果:非驱血状态下,止血带安放后的6min内,桡动脉压逐渐降低,头静脉压先迅速上升后逐渐下降,6min后,动静脉压持平并稳定在20.0mmHg;驱血状态下,止血带安放后的6min内,桡动脉压骤降至-0.5mmHg后缓慢上升,头静脉压骤降至0.5mmHg后缓慢上升,6min后,动静脉压持平并稳定在2.0mmHg左右。驱血或非驱血状态下,皮瓣制备中均无动脉性出血,制备完毕放松止血带后,未被结扎的动脉在压力作用下均发生肉眼可见的喷射性出血,可被发现并及时加以结扎。非驱血状态下静脉有适度充盈,便于辨认和结扎,放松止血带后几乎无静脉渗血;而在驱血状态下,静脉无血液而塌陷,难以辨认和有效结扎,放松止血带后皮瓣渗血机会明显增加。结论:非驱血状态下制备组织瓣具有明显优点:可简化操作,缩短手术时间,不增加术中动脉出血,减少术后皮瓣渗血的机会。     

The value of Allen's test in harvesting a radial forearm flap: correlation of ex-vivo angiography and histopathological findings

The radial forearm flap is one of the most commonly raised free flaps. In most cases an Allen's test is sufficient for preoperative assessment of the palmar arch, but an intact palmar arch does not imply that the radial artery is suitable for microvascular anastomosis. For a patient operated for oral squamous cell carcinoma, reconstruction was planned with a radial forearm flap. The flap had to be discarded because of advanced atherosclerosis in the presence of a negative Allen's test. The correlation of an ex-vivo angiography and the histopathologic findings was assessed. In cases of expected vascular disease, further examinations like color flow Doppler ultrasound are recommended to ensure sufficient perfusion of the radial artery.     

游离前臂皮瓣移植术后对手功能影响的研究

目的 探讨口腔颌面部软组织缺损应用前臂游离皮瓣修复后对手功能的影响。方法 选择36例行游离前臂皮瓣移植的患者,评估患者左手臂的手功能,包括皮温、肘关节与腕关节屈伸度、握力值、末梢指甲微循环测试、冷、热觉、痛觉及外形美观评价。选择患者的右侧手臂作为对照,进行相同测试。进行同一患者左右侧对比分析,统计学方法采用配对t检验和秩和检验。结果 患者左右手的握力不存在显著差异;前臂皮瓣供瓣区的感觉功能较对侧有显著差异;5例左手虎口区有麻木感的患者左虎口区的感觉功能较对侧有显著差异,其余31例患者左手虎口区的感觉功能较对侧无显著差异;左手皮温,末梢指甲微循环及肘关节、腕关节屈伸度的检查结果与对侧相比无显著差异。结论 游离前臂皮瓣移植修复虽需牺牲桡动脉这一前臂主要供血动脉,但通过尺动脉的代偿作用及侧枝循环的完善,患者手部的血供仍然可以得到保证。配合术中小心操作,避免神经的损伤,那么将对前臂中远期运动功能及感觉功能无明显影响。     

Patency of the radial artery following intra-luminal cannulation and its influence on potential flap harvest for head and neck reconstruction

The radial forearm free flap (RFFF) is well-established in head and neck reconstruction, but early potential failure may necessitate a contingency plan, which could include the opposite RFFF if cannulation of the relevant artery at the time of the first operation did not influence its patency. We prospectively studied patients listed for major operations who required radial artery cannulation. They all had perioperative imaging of the radial artery with colour flow duplex before cannulation and at intervals after the cannula had been removed (2 h–7 days). Forty patients were recruited (mean age 65 years, range 32–91). Thirty-three had patent vessels within 2 h of the cannula being removed, and 39/40 at 24 h. Patency after removal of the cannula returns rapidly, and is almost always complete by 24 h. In most people the contralateral radial forearm could therefore be used to mode of salvage reconstruction if the flap failed early.     

Aesthetic and functional results of harvesting radial forearm flap, especially with regard to hand function

There is controversy in the literature regarding donor site morbidity following radial forearm flap harvesting. The aim of this study was to verify possible functional and aesthetic impairments at the donor site. Thirty-five patients who underwent maxillofacial reconstruction using radial forearm flap were asked to give their subjective assessment of the aesthetic outcome at the donor site and of postoperative hand function. They were also examined for trophic status; cold intolerance and tactile sensitivity of split-thickness skin graft, palm and finger pads; grip strength and finger-to-thumb pinch strength; range of movement for the wrist and finger joints; as well as functional hand testing. Slight impairments regarding hand strength and mobility were observed. However, due to their small extent they were of no clinical relevance, as shown by 85.7% of our patients displaying optimal functional hand testing values (80-100%), and 88.6% giving a positive subjective assessment (80-100%) of postoperative vs preoperative hand function. The results show that donor site morbidity following radial forearm flap harvesting is low.     

50例口腔颌面部游离前臂皮瓣移植的临床分析

目的：对50例口腔颌面部游离前臂皮瓣移植作回顾性分析。方法：1999年5月26日－2000年8月3日期间完成的连续50例游离前臂皮瓣移植，分析所采用组织瓣的设计，受区血管，血管吻合方式和技术，皮瓣成活情况及术后并发症的发生情况，并分析有可能影响皮瓣成活的各种因素。结果：50例前臂皮瓣全部成活，成功率100％，无一例发生全部或部分坏死，皮瓣术后血栓的发生率为6％，均为静脉血栓，抢救成功率为100％；受区和供区总的并发症发生率为28％，但大多数并发症均不严重，没有造成明显的后果，吸烟，饮酒，放疗和年龄（高龄和儿童）等均非影响游离组织瓣移植成功的重要因素。结论：游离前壁皮瓣在口腔颌面部缺损的修复中具有很大的灵活性，其制备简便，安全可靠，明显优于传统的带蒂组织移植，值得推广和应用。     

Reversible ischaemia after raising a radial forearm flap with ulceration of three fingers in a cigarette smoker

The radial forearm flap is a standard method for the reconstruction of intraoral defects of soft tissues. We report the case of a middle-aged man who developed ischaemia in three fingers after a fasciocutaneous radial flap had been raised. The preoperative Allen test to diagnose occlusion of radial or ulnar artery was satisfactory. Soon after the operation the patient resumed smoking and four weeks later he developed ulcers on the thumb, index, and middle fingers. Only after he had stopped smoking and been given acetylsalicylic acid and heparin did blood flow and capillary hemoglobin oxygenation increase. As a result, his radial fingers recovered completely.     

面部口腔洞穿性缺损前臂皮瓣折叠修复临床研究

目的：总结前臂皮瓣折叠修复颌面部洞穿性缺损的临床应用及特点。方法：9例恶性肿瘤根治术后,颊部口腔软组织洞穿性缺损5例,颏部皮肤及下唇黏膜缺损3例,颊部、口腔及下颌骨硬软组织缺损1例。应用前臂皮瓣一期折叠修复口腔颌面部的洞穿性缺损,前臂皮瓣的一部分修复口腔黏膜,一部分修复面部缺损。结果：9例前臂皮瓣术后全部存活。术后随访2～48周,颌面部外形恢复及口腔功能恢复满意。结论：前臂皮瓣折叠修复颌面部洞穿性缺损效果可靠,外形满意,值得临床推广应用。     

Clinical and histological results of sensory recovery after radial foreann flap transfer

The necessity of nerve anastomosis in an attempt to regain dermal sensitivity following pedicled or free-flap transfer has been the basis of many discussions. In our study, we investigated the degree of sensory recovery with emphasis on the different nerval qualities, on the radial forearm flap and correlated it to the histological and immunohistological findings. Nineteen patients with radial forearm free flap--five of whom underwent nerve anastomosis--were examined. The follow-up interval was 20.3 months (average) after surgical intervention. Histological examinations were performed on 13 of the 19 patients, in eight cases on one occasion and in five on more than one occasion. Seventeen patients experienced sensory recovery, whereby the degree and quality of dermal innervation varied. In comparison, the nerval reconstruction did not lead to any significant improvement. Based on our clinical results, we regard the nerve reconstruction during the radial forearm free flap transfer as unnecessary. To what extent this can be said for other flaps demands further investigation.     

An unusual anomaly of the radial artery with potential significance to the forearm free flap. Case report.

INTRODUCTION: The radial forearm free flap has become the favourite transplant for microsurgical repair of small-to-medium sized soft tissue defects of the oral cavity. This flap derives its blood supply from perforators of the radial artery. As the radial forearm flap gains ever more popularity, it is likely that anomalous forearm vascular patterns will be encountered by more surgeons. PURPOSE: In this paper, a rare anomaly found in a patient during flap elevation is described. This 63-year-old male had a squamous cell carcinoma of the floor of the mouth and a radial forearm free flap was harvested to repair the defect. During this procedure an aberrant duplication of the radial artery was found which could have significance in harvesting such a flap in other patients. CONCLUSION: There are anomalies of the radial artery that may jeopardize the vascular supply to the radial forearm free flap. Surgeons performing this flap must be aware of the most common variants of the vascular anatomy of the forearm.     

前臂游离皮瓣行颌面部组织缺损修复术11O例

目的 :总结前臂桡侧游离皮瓣修复口腔颌面软组织缺损的经验。方法 :对 110例前臂桡侧游离皮瓣修复口腔颌面软组织缺损的病例进行临床分析。结果 :前臂桡侧游离皮瓣修复口腔颌面部各类软组织缺损 110例 (硬软腭缺损修复再造 3例 ) ,其中 1例为双前臂桡侧游离皮瓣。 10 5例全部存活 (尿毒症伴舌癌患者 1例 ) ,1例大部份存活 ,成功率 96.4% ,失败 4例。结论 :前臂桡侧游离皮瓣解剖恒定、制备方便 ,厚薄适中、便于折叠、血管蒂长 ,是一种修复口腔颌面软组织缺损的优良皮瓣 ,也是口腔颌面部软组织缺损修复的首选皮瓣     

应用皮瓣行颌面器官再造术10例报告

目的观察颌面部大面积组织缺损病例,用皮瓣修复组织的缺损及行器官再造,对患者面容的恢复情况. 方法舌癌5例,口底癌4例,面部疤痕1例术后造成面部、舌、牙龈、口底及颊等部位的缺损,分别用颈阔肌肌皮瓣,胸锁乳突肌肌皮瓣,胸大肌肌皮瓣,游离前臂皮瓣,游离足背皮瓣等修复,术后分别给予抗感染、抗凝等治疗,以利皮瓣成活.结果术后除1例胸大肌肌皮瓣部分坏死外,其余均成活.结论皮瓣修复颌面组织缺损及行器官再造术是可行的,效果可靠.胸大肌肌皮瓣是舌再造的较好方法.