尺动脉腕上皮支皮瓣的临床应用

1996年以来 ,我们应用尺动脉腕上皮支皮瓣修复手部皮肤缺损 10例 ,取得良好效果。1　病例资料本组 10例 ,男 7例 ,女 3例 ,年龄18～ 5 1岁。机器挤压致手背部皮肤坏死、肌腱外露 3例 ,虎口瘢痕挛缩 3例 ,外伤性拇指合并虎口软组织缺损 1例 ,手掌皮肤缺损 3例。2　手术方法受区彻底清创后 ,根据皮肤缺损大小设计皮瓣。以豌豆骨与肱骨内上髁连线为皮瓣轴心线 ,豌豆骨近端 4ｃｍ处为皮瓣关键点 ,皮瓣切取范围远端可达豌豆骨 ,近端可达肱骨内上髁 ,两侧分别达前臂掌侧和背侧正中线。按设计先在腕上切开皮瓣桡侧缘 ,向尺侧游离 ,显露尺侧腕屈肌 ,…     

Distally based perforator medial plantar flap: a new flap for reconstruction of plantar forefoot defects

In this article the author describes 2 cases of a distally based perforator medial plantar flap that were transferred successfully from the nonweight-bearing instep region to the weight-bearing plantar forefoot (defects, 8 x 5 cm and 6 x 5 cm respectively). This flap is nourished solely by perforators of the medial plantar vessels. The advantages of this flap are the protection of the vascular supply of the foot (because both posterior tibial and medial plantar vascular systems are preserved), anterograde flow of the vascular supply (which gives an additional advantage of expecting less venous insufficiency compared with reverse-flow flaps), no dependence on retrograde vascular communications, minimal donor site morbidity, and transport of structurally similar tissues to the plantar forefoot.     

应用小腿内侧逆行带蒂皮瓣修复足底皮肤缺损

目的 报告应用小腿内侧的逆行带蒂皮瓣修复足底皮肤缺损的临床效果.方法2002年1月到2008年5月,对直接或间接原因导致足底皮肤缺损的12例患者,采用小腿内侧逆行带蒂皮瓣进行修复,皮瓣切取面积为10 cm×7 cm～13 cm×12 cm.结果 术后皮瓣远端血运障碍出现部分坏死2例,经换药治愈1例,行二期手术修复1例,其余10例皮瓣均完全存活.经6～18个月随访,皮瓣外形良好,质地优良,功能恢复满意.结论 应用小腿内侧胫后动脉皮支逆行的带蒂皮瓣修复足底皮肤缺损,效果满意.

Abstract：

Objective To introduce clinical application of retrograde medial pedicled skin flap of the leg to repair the plantar cutaneous deficiency. Methods From January 2002 to May 2008, in our hospital we adopted retrograde medial pedicled skin flap to renovate 12 cases of plantar cutaneous deficiency. The size of the skin flaps ranged from 10 cm× 7 cm to 13 cm × 12 cm. Results Ten cases of retrograde medial pedicled skin flap were survived, the rest had partial necrosis because of distal blood flow obstacle. One was cured by changing dressings; the other was repaired by secondary operation. Morphology and function of soft tissue defects were renovated well with 6-18 months follow-up. Conclusion This operation is an effective and reliable technique for plantar cutaneous deficiency.     

Hypothenar flap based on a cutaneous perforator branch of the ulnar artery: an anatomic study

This study describes a constant cutaneous perforator branch of the ulnar artery of the hand and a hypothenar arterial flap based on it. Eighteen amputated hands of 10 fresh cadavers were used for the study. Red latex was injected into the axillary arteries of nine specimens and radiopaque lead oxide-gelatin mixture into the remaining nine. Then, the cutaneous perforator branch of the ulnar artery was identified by marginal dissection and radiographed. The cutaneous perforator branch was found constantly in all 18 specimens and was named the "hypothenar perforator" (HP). On radiograph, a coordinate was set up with an origin (pisiform), a transverse x (through the pisiform and hamate of the carpal bones), and a proximal to distal y (through the pisiform and 4th interdigital web) axes. The HP was situated at 10.1 +/- 3.6 mm lateral to the pisiform (on the x axis) and 20.0 +/- 7.0 mm distal (on the y axis). A hypothenar flap based on the HP is suitable for covering small defects of the fingers, and the donor site can be closed primarily.     

Island medial plantar artery perforator flap for reconstruction of plantar defects

Three cases in which island medial plantar artery perforator flaps were successfully transferred for coverage of the plantar defects are described. This perforator flap is different from the medial plantar flap based on the medial plantar artery. The flap has no fascial component and is nourished only with the perforator of the medial plantar vessel. Therefore, transection of the medial plantar artery is usually unnecessary. This flap can cover defects on the forefoot and heel without transaction of the medial plantar system. The advantages of this flap are no need for deep or long dissection for the medial plantar vessel, no exposure of the plantar sensory nerve, a short time for flap elevation, minimal donor-site morbidity, relatively large flap survival, and no damage of both the posterior tibial and medial plantar neurovascular systems.     

正中神经掌皮支营养血管远端蒂肌皮复合瓣解剖学研究及临床应用

目的 探讨正中神经掌皮支营养血管肌皮瓣转移术修复拇指组织缺损的解剖学依据及临床效果.方法 对30侧成人尸体手标本进行解剖,系统观测正中神经掌皮支营养血管链的组成、分支、分布及其同大鱼际肌相互交通吻合的情况.2007年2月以来,临床应用正中神经掌皮支营养血管远端蒂肌皮瓣转移术修复拇指组织缺损17例.结果 桡动脉掌浅支恒定地向拇短展肌和拇短屈肌发出3～5支肌皮穿支,节段性参与正中神经掌皮支营养血管链,肌皮穿支平均外径为[(0.3±0.1)mm,x±s,下同],均有1条静脉伴行.17例术后肌皮瓣全部存活,拇指外观及功能满意,11例患者在术后1周皮瓣两点分辨觉为(6.1～8.2)mm.结论 正中神经掌皮支营养血管链同拇短展肌和拇短屈肌肌皮穿支恒定吻合,该肌皮瓣是修复拇指组织缺损的良好供区.     

Toe-to-hand transfer based on the medial plantar artery

Two patients had toe-to-hand transfers based on the medial plantar artery system. The dorsalis pedis and first dorsal metatarsal arteries were absent in both cases. Although the procedure is slightly more complicated than currently described techniques for toe-to-hand transfers based on the dorsal system, the procedure was performed in both cases without complication.     

足底内侧动脉分支蒂皮瓣的临床研究

目的 探讨以足喊内侧动脉分支为蒂皮瓣的设计及临床应用效果。方法 在解剖基础上以足底内侧动脉及其分支为血管蒂，设计足内侧皮瓣、足底内侧皮瓣、联合皮瓣及双叶皮瓣顺、逆行转位或游离移植修复53例于足部皮肤缺损创面。结果 临床应用53例，51例皮瓣完全成活。45例术后随访6～24个门，皮瓣质地优良，手、足外形与功能改善满意。结论 该类皮瓣切取方便，血供可靠，厚薄适中，外形佳，足修复手、足部皮肤缺损的理想选择。双叶皮瓣及逆行皮瓣为临床提供了实用性的新方法。     

Clinical application of the free flap based on the cutaneous branch of the acromiothoracic artery

The nasal reconstruction in 8 patients and cheek reconstruction in 1 using a free flap from the deltoid region has been successfully undertaken in our department since August 1987. The flap has a direct cutaneous artery--the acromial artery--as its vascular axis. The experiences and a brief anatomical review of the donor site are reported.     

微型尺动脉腕上皮支上行支皮瓣游离移植修复手指创面

目的报道应用微型尺动脉腕上皮支上行支皮瓣游离移植修复手指创面的临床效果。方法在前臂远端尺侧沿尺骨与尺侧腕屈肌间隙于腕上4～9 cm范围内设计皮瓣。皮瓣面积最大4．0 cm×3．0 cm,最小2．5 cm×1．5 cm；修复创面的面积最大为3．5 cm×2．5 cm,最小为2．0 cm×1．5 cm。皮瓣供血动脉为尺动脉腕上皮支的上行支,皮瓣静脉为前臂尺侧浅静脉,皮瓣的神经为前臂内侧皮神经的终末支。结果临床应用16例,术后皮瓣均成活,外形不臃肿,感觉恢复良好,其中S_4 4例,S_3~+9例,S_3 3例,S_2及以下0例,S_3~+及以上者81．25%。结论微型尺动脉腕上皮支上行支皮瓣游离移植修复手指创面,不牺牲主要血管,创伤小,术后手指的外观及感觉功能较好,是修复手指创面的可行方法之一。     

腓肠肌内侧头穿支动脉与腓肠神经营养血管联合蒂肌皮瓣的临床应用

目的 探讨腓肠肌内侧头穿支动脉与腓肠神经营养血管联合蒂肌皮瓣的临床应用效果.方法 自2006年2月至2010年3月,根据缺损部位及大小设计以腓肠肌内侧头穿支动脉与腓肠神经营养血管轴的联合蒂,沿腓肠肌内侧头血管轴切取皮瓣,顺行移位修复膑前及胫骨上段皮肤及软组织缺损7例.皮瓣切取范围8.0 cm×8.0 cm～12.0 cm×10.0 cm,联合血管蒂长1.8～3.0 cm,联合血管蒂发出位于腘褶皱以远10.0 ～ 17.0 cm,距后正中线2.0～5.0 cm的范围内.结果 6例伤口一期愈合.1例发生皮瓣远端表浅干性坏死,面积约1 cm×2 cm,经换药后逐渐愈合.随访6～ 15个月,无任何并发症,肌皮瓣质地优良,外观满意.结论 腓肠肌内侧头穿支动脉与腓肠神经营养血管联合蒂肌皮瓣手术操作简便,血供可靠且不牺牲主要动脉,切取面积大,转移距离长,为临床修复髌前及胫骨上段皮肤及软组织缺损提供了一种新方法.     

Distally based lateral plantar artery island flap

We report on the reconstruction of the lateral metatarsal head defect by a distally based lateral plantar artery island flap using the flexor digitorum brevis muscle. The pedicle for this flap was provided by a retrograde lateral plantar artery. We found that this flap was relatively simple and easy to perform and could cover large defects better than any other conventional local flap.     

小腿内侧逆行皮支皮瓣交腿应用的体会

目的探讨小腿内侧逆行穿支皮瓣在临床上交腿应用的修复效果及经验。方法自2009-01—2013-12,4例小腿远端胫腓骨骨折内固定术后断端、胫前肌腱和内固定物缺少皮肤软组织覆盖,一期行交腿皮瓣修复;10例行骨折固定手术或清创术后出现皮肤软组织坏死,再次清创后创面内骨、肌腱、内固定物外露,二期交腿皮瓣修复;3例小腿、足踝部外伤在非手术治疗过程出现皮肤坏死,清创后骨、肌腱外露,后采用交腿皮瓣修复治疗。结果本组17例均获得平均8.2(6~12)个月随访。16例皮瓣断蒂后成活良好。1例皮瓣断蒂后缝合创面蒂部皮瓣封闭创面,3 d后皮瓣出现红肿,将封闭创面敞开引流,之后皮瓣红肿消退,逐渐愈合。14例皮瓣愈合后外观良好,3例为改善皮瓣臃肿外观后期行皮瓣修整术。结论小腿内侧逆行穿支皮瓣在交腿应用时,皮瓣切取操作更简单,供区损伤更小,临床修复效果良好,适用于修复小腿、足踝部皮肤缺损。     

Bipedicled distally based medial plantar artery perforator flap for forefoot reconstruction: A case report

Reconstruction of soft-tissue defects in the foot weight-bearing area should encompass sensate and robust skin. Regarding forefoot defects, distally based medial plantar artery (MPA) flap is an ideal option. However, considering variation of the terminal branches of the MPA, reverse flow flaps can be unreliable with an increasing risk of venous congestion or insufficient arterial flow. In this report, we present a case of the use of reverse flow MPA flaps with dual flow vascularization. The patient was a 37-year-old female who presented a 7 × 3 cm soft-tissue defect of the right forefoot after wide local excision following melanoma. Reconstruction happened with a perforator distally based bipedicled flap (8 × 4 cm) on the MPA though keeping an enhanced vascularization through both superficial (sMPA) and deep (dMPA) medial plantar arteries. Donor site was closed with skin graft. Patient was discharged from hospital at postoperative Day 10 and healed uneventfully with progressive start walk was possible again. A full weight bearing with normal shoes was possible after 8 weeks. Good healing and no functional impairment were present after 9 months of follow-up. We believe this dual vascularization concept may be adopted when possible to improve the overall circulation of the flap and to prevent risks of vascular insufficiency or vein congestion.     

带隐神经小腿内侧筋膜皮支皮瓣修复重度虎口挛缩应用体会

自1997年以来,我们采用带隐神经小腿内侧筋膜皮支皮瓣修复重度虎口挛缩7例,重建虎口外形美观,感觉恢复,临床效果满意.现报告如下.