前臂远端蒂复合血管网皮瓣修复腕手部皮肤缺损

目的探讨前臂远端蒂复合血管网皮瓣的血供特点及临床疗效。方法2000年2月~2003年12月,应用包含深筋膜、皮神经及浅静脉的前臂远端蒂复合血管网皮瓣修复掌指关节以近、近侧腕横纹以远的手及腕部伴肌腱或骨外露创面26例,男17例,女9例。年龄18~56岁。急诊修复16例,择期修复10例,皮瓣范围10 cm×5 cm~18 cm×7 cm。结果术后26例皮瓣完全成活,随访3~8个月,皮瓣质地优良,不臃肿,耐磨,腕及手指功能恢复良好;两点辨别觉6~10 mm。结论皮神经、浅静脉营养血管网与真皮下及深筋膜血管网经穿动脉相互联系,构成三维立体轴向的血供,是皮瓣成活的解剖基础,蒂部远端的主干血管穿支是皮瓣的血供来源。手术操作安全,成活率高,质地优良,适合修复腕手部皮肤缺损。     

小腿远端蒂复合血管网皮瓣修复足踝部皮肤缺损

目的探讨小腿远端蒂复合血管网皮瓣的血供特点及临床疗效。方法2004年2月～2005年12月,应用包含深筋膜、皮神经及浅静脉的小腿远端蒂复合血管网皮瓣修复足踝部皮肤缺损伴肌腱或骨外露创面16例,其中急诊修复6例,择期修复10例。男11例,女5例;年龄16～48岁。皮瓣切取范围9cm×5cm～17cm×14cm。结果术后16例皮瓣均成活,切口期愈合。患者均获随访1～8个月。皮瓣血循环良好,耐磨无破溃,有浅痛觉及触觉,两点辨别觉40～96mm,受区臃肿不明显。供区创面期愈合。结论小腿远端蒂复合血管网皮瓣操作安全,成活率高,是修复足踝部皮肤缺损的一种有效方法。     

吻合浅静脉的逆行皮神经营养血管皮瓣的应用

目的探讨吻合浅静脉的皮神经营养血管逆行皮瓣临床应用的效果。方法1996年6月起对19例肢体远端皮肤缺损采用皮神经营养血管逆行皮瓣移位修复,其中皮肤创伤性缺损10例,慢性溃疡3例,瘢痕挛缩6例。采用腓肠神经营养血管皮瓣9例,隐神经营养血管皮瓣2例,前臂内侧皮神经营养血管皮瓣5例,前臂外侧皮神经营养血管皮瓣3例。术中将皮瓣远端的浅静脉与受区皮下静脉作端端吻合以改善静脉回流。皮瓣范围15cm×24cm～4cm×6cm,血管蒂长6～15cm。结果17例皮瓣完全成活,1例前臂内侧皮神经皮瓣修复手掌创面及1例腓肠神经皮瓣修复足内侧瘢痕创面,术后因吻合的静脉栓塞致皮瓣远端部分坏死。16例获得6～24个月随访,皮瓣质地优良,恢复保护性感觉,外形及功能改善满意。结论吻合浅静脉可以明显改善该类皮瓣的静脉回流,扩大皮瓣成活面积及修复范围。     

浅静脉皮神经营养血管蒂逆行皮瓣修复手部皮肤缺损

目的报道三种吻合浅静脉的皮神经营养血管蒂逆行岛状皮瓣转位术的临床疗效.方法从1998年7月～2001年3月应用三种吻合浅静脉的皮神经营养血蒂管皮瓣修复手部皮肤软组织缺损16例,皮瓣最大面积20cm×8cm,最小面积4cm×3cm,其中头静脉桡神经浅内侧支营养血管皮瓣4例,贵要静脉前臂内侧皮神经营养血管皮瓣5例,头静脉前臂外侧皮神经营养血管皮瓣7例.结果 16例皮瓣均顺利成活,皮瓣未出现明显肿胀及瘀血.结论皮神经营养血管皮瓣逆行转位后,吻合一条浅静脉对皮瓣的顺利成活、肢体的静脉回流及皮瓣的超大面积切取具有积极的意义.     

小隐静脉-腓肠神经营养血管岛状皮瓣的应用

目的探讨用小隐静脉-腓肠神经营养血管逆行岛状皮瓣修复下肢远端软组织缺损的效果.方法用小隐静脉-腓肠神经营养血管逆行岛状皮瓣修复踝周、足跟、足底及足背皮肤软组织缺损26 例,皮瓣面积为6 cm×5 cm～22 cm×10 cm,筋膜蒂长6～13 cm.结果随访时间6～46个月,皮瓣全部成活.皮瓣与周围皮肤颜色一致、质地柔软,外观及功能满意.结论小隐静脉-腓肠神经营养血管逆行岛状皮瓣血供可靠,不损伤主干血管,切取容易,是修复踝周、足跟、足底及足背皮肤软组织缺损的理想皮瓣.     

腓肠神经-小隐静脉营养血管远端蒂皮瓣动脉穿支的应用解剖

目的研究腓肠神经-小隐静脉营养血管远端蒂皮瓣动脉穿支的分布规律及临床应用。方法对30侧动脉灌注红色乳胶成人下肢标本,解剖观测远端蒂部的动脉来源及分布。2003年1月～2004年8月,在解剖学研究的基础上,临床采用低旋转点的腓肠神经-小隐静脉营养血管远端蒂皮瓣36例。其中男21例,女15例。年龄6～66岁,平均35.2岁。足跟及足底部皮肤缺损18例,足背部缺损10例,中前足缺损8例,均伴有骨、肌腱外露。缺损范围:3.5cm×2.5cm～17.0cm×11.0cm,切取皮瓣4cm×3cm～18cm×12cm。结果远端蒂动脉穿支2～5支,来源于跟外侧动脉穿支及外踝后动脉穿支,外径0.6±0.2mm和0.8±0.2mm,距外踝尖上1.0±1.3cm和2.8±1.0cm。腓动脉肌间隔穿支0～3支,出现率依次为96.7%、66.7%和20.0%,外径0.9±0.3、1.0±0.2和0.8±0.4mm,距外踝尖上5.3±2.1、6.8±2.8和7.0±4.0cm。动脉穿支发出皮支、皮神经浅静脉营养支和深筋膜支,形成腓肠神经-小隐静脉营养血管链和深、浅筋膜血管网。临床应用36例皮瓣全部成活,仅3例术后皮瓣边缘少量坏死,经换药后愈合。所有患者经8～16个月随访,供区外形良好,患肢能正常行走,皮瓣感觉逐步恢复。结论以外踝后动脉穿支为蒂,皮瓣旋转点在外踝尖上3.0cm。以跟外侧动脉穿支为蒂,皮瓣旋转点近外踝尖平面。     

前臂外侧皮神经营养血管远端蒂皮瓣的临床应用

目的报道前臂外侧皮神经营养血管远端蒂皮瓣的临床应用疗效。方法根据前臂外侧皮神经营养血管皮瓣血供来源及其与前臂筋膜皮肤血供的相互关系，在前臂外侧设计皮神经营养血管远端蒂皮瓣，转位修复手部、腕部及前臂远端软组织缺损19例。结果术后皮瓣完全成活，创面一期愈合，经3～30个月随访，皮瓣外形与手部功能恢复满意。结论前臂外侧皮神经营养血管远端蒂皮瓣解剖位置恒定，血液供应良好，手术方法简单，适用于修复手部、前臂软组织的缺损。     

皮神经伴行血管蒂逆行岛状皮瓣的临床应用

目的 :探讨皮神经伴行血管蒂逆行岛状皮瓣的临床应用。方法 :使用前臂外侧皮神经伴行血管蒂逆行岛状皮瓣修复腕掌、腕背及虎口部皮肤软组织缺损 5例。腓肠神经伴行血管蒂逆行岛状皮瓣修复小腿远端、足跟足背皮肤软组织缺损 10例。皮瓣切取面积 5 cm× 5 cm～ 15 cm× 9cm。结果 :15例皮瓣 ,13例完全成活。1例皮瓣远端边缘 0 .5 cm坏死 ,经换药后愈合。 1例皮瓣坏死 ,创面植皮后愈合。结论 :皮神经伴行血管蒂逆行岛状皮瓣血供可靠 ,切取简便、安全 ,不牺牲主要血管 ,是修复四肢皮肤软组织缺损较好的方法之一     

前臂及拇背侧皮神经营养血管蒂岛状皮瓣的临床应用

目的探讨前臂及拇背侧带皮神经营养血管蒂岛状皮瓣临床应用的适应证。方法利用以前臂外侧皮神经营养血管为蒂的岛状皮瓣修复拇指末节脱套伤2例,带拇背桡侧皮神经营养血管蒂岛状皮瓣及尺背侧皮神经营养血管蒂逆行岛状皮瓣修复拇指掌侧软组织缺损10例。皮瓣切取面积2cm×3cm～7cm×11cm。结果11例皮瓣全部成活,1例前臂外侧皮神经皮瓣因切取面积较大导致远端部分坏死。结论以前臂皮神经营养血管为蒂的岛状皮瓣适用于拇指末节脱套伤,但皮瓣长度不应超过11cm;拇背侧皮瓣宽度较小,仅适宜修复拇指较小面积的软组织缺损。     

远端蒂指背皮神经营养血管皮瓣修复指腹创伤缺损

目的介绍应用指背皮神经营养血管皮瓣修复指腹创伤缺损的临床经验,并探讨改善静脉回流的方法。方法自2004年3月至2005年10月,共急诊应用远端蒂指背皮神经营养血管皮瓣,修复指腹创面大于2 cm者18例。旋转轴点在近侧指间关节(PIP)平面以近0．5 cm,皮瓣面积2 cm×2 cm～3 cm×4 cm,皮神经筋膜蒂长2～3 cm。均将指背皮神经与指固有神经吻接,并在旋转点远侧1 cm处结扎指背浅静脉。结果术后皮瓣均有不同程度的静脉淤血肿胀,8例皮瓣出现张力水泡。13例随访超过6个月,皮瓣恢复保护性感觉。结论指背皮神经营养血管皮瓣修复指腹创伤缺损,方法简单,成活可靠。在蒂部远侧结扎指背浅静脉干阻断倒灌和在末端旷置敞开,均能改善静脉回流,减轻皮瓣肿胀。     

Anatomic study of distally based pedicle compound flaps with nutrient vessels of the cutaneous nerves and superficial veins of the forearm

The purpose of this study was to describe the anatomic basis for a distally based neurovenovascular pedicle compound flap, with nutrient vessels of the cutaneous nerves and superficial veins of the forearm. In this study, the origins, branches, and anastomoses of nutrient vessels of the cutaneous nerves and superficial veins of the forearm and their relationships with the blood supply of adjacent muscle, bone, and skin were assessed in 96 adult cadavers by perfusion of red gelatin into the superior limb arteries. The results showed that the nutrient vessels of cutaneous nerves and superficial veins of the forearm were found to have multiple origins, consisting of six longitudinal vascular plexuses and one transverse vascular plexus of the forearm, as follows: 1) the anterior-lateral vascular plexus from cutaneous branches of the radial artery; 2) the anterior-medialis vascular plexus from cutaneous branches of the ulnar artery; 3) the dorso-lateral vascular plexus from radial osteal and cutaneous branches; 4) the dorso-medialis vascular plexus from ulnar osteal and cutaneous branches; 5) the radial vascular plexus from osteal and cutaneous branches of the radial artery, cutaneous branches of the radial artery in the upper wrist, recurrent branches of the styloid process of the radius, and the radialis vascular plexus of cutaneous branches of the tabatière anatomique (anatomical snuffbox); and 6) the ulnar lateral vascular plexus from cutaneous branches of the ulnar artery in the upper wrist and osteal and cutaneous branches. The transverse vascular plexus is composed of dorsal branches of the ulnar and radial arteries. These perforating branches give fascial branches, cutaneous branches, periosteal branches, and nutrient vessels of cutaneous nerves and superficial veins. These results suggest that nutrient vessels of the cutaneous nerves and superficial veins of the forearm have the same origins as those of the nutrient vessels of adjacent muscles, bones, and skin of the forearm, which can be designated as five types of distally based pedicle flaps with nutrient vessels of cutaneous nerves and superficial veins of the forearm, whose rotation point is at the wrist joint. This flap can be applied to repair tissues of distal parts of the hand.     

A new distally pedicled adipocutaneous perforator forearm flap]

A new distally pedicled adipocutaneous perforator forearm flap useful in corrections of congenital anomalies of hand was described. Due to the congenital anomaly expression the perforators may origin from radial, median, ulnar or anterior interosseous artery which supply blood flow into the flap tissues. Raising the flap from anterior and radial surface of the forearm begins from the proximal to the distal part, above the fascia leaving superficial cutaneous nerves and cephalic vein intact. The flap may be safely incised in the ratio 5:1 and the pivot point is localized in the place where perforators pierce the forearm fascia usually 1-2 cm above the rascetta. Rerouting of the flap distally on the hand makes reconstruction of missing thenar, the first web space or even finger tissues possible. These conditions are basal for further reconstruction in advanced hypoplasia of the radial part of hand. Similar flap may be used in the posttraumatic cases when the flap blood supply comes exclusively from radial artery perforators.     

The distally based radial artery/flexor carpi radialis muscle flap for dorsal hand reconstruction: a clinical and cadaver study

Complex soft tissue defects of the hand often require vascularized tissue for protection and coverage of exposed underlying structures. Pedicled local flaps from the forearm are one reconstructive option, but its use is limited by relatively high donor-site problems, including a disagreeable forearm scar and potential division of superficial forearm nerves. We describe a pedicled local flap option--the distally based radial artery/flexor carpi radialis flap, which potentially decreases forearm donor-site morbidity while still providing for coverage of small hand soft tissue defects. Six cadaver forearm dissections were performed to confirm that the vascular supply to the middle and distal portion of the flexor carpi radialis comes off the radial artery. Four clinical cases are presented in which the flexor carpi radialis muscle based on the distal radial artery was used to cover complex wounds of the dorsum of the hand. We believe the lack of damage to the superficial sensory forearm nerves and the ease of flexor carpi radialis muscle flap elevation make this a versatile flap for small, complex, soft tissue defects of the hand.     

远端为蒂的隐神经-大隐静脉筋膜皮瓣修复下肢软组织缺损

目的探讨远端蒂隐神经-大隐静脉筋膜皮瓣修复下肢软组织缺损的方法和临床效果。方法对32例足部、踝部及小腿下端的皮肤缺损创面，采用远端蒂隐神经-大隐静脉筋膜皮瓣逆行移位修复。结果32例皮瓣全部成活，其中2例有部分皮瓣坏死，须再次行游离植皮术。32例获6个月～3年随访，28例皮瓣外观、血运、质地、色泽、弹性好，4例皮瓣须二期修整。结论远端为蒂隐神经-大隐静脉筋膜皮瓣操作简单，不牺牲肢体主要血管，皮瓣质地好，厚度适中，是一种修复下肢远端皮肤软组织缺损创面的理想皮瓣。     

带血管蒂皮瓣修复足跟部缺损

目的：探讨足跟部软组织缺损皮瓣修复的治疗效果。方法：应用６种带血管蒂皮瓣移植进行修复。结果：本组３２例，经随访半年～６年，除２例皮瓣部分坏死，其余３０例皮瓣成活良好，功能改善。结论：由于足底皮肤缺损修复的特殊性，应用带蒂皮瓣移植修复，血供丰富，有益于足跟功能重建，根据缺损的具体情况，选择不同的带蒂皮瓣，并证实了带腓肠神经伴行血管蒂逆行岛状皮瓣移植为修复跟底皮肤缺损的一种较好方法。     

跨区供血腓动脉外踝上穿支蒂腓浅神经营养血管皮瓣修复足前部缺损

目的 探讨改良腓浅神经营养血管皮瓣修复足前部缺损的手术方法及临床效果.方法 对足前部皮肤软组织缺损创面,设计切取以外踝上穿支或其降支为蒂,经其升支、胫前动脉皮穿支及腓浅动脉跨区供血的腓浅神经营养血管皮瓣修复.结果 2005年2月至2008年2月,于临床应用17例,最远修复至第2、3趾基底部及第5跖骨头负重区,最大切取面积20 cm×8 cm;皮瓣均全部成活,术后随访6～12个月,皮瓣质地优良,外形与足踝功能恢复满意.结论 该皮瓣神经血管丛粗大而丰富,蒂部供血确切,旋转修复距离可达足趾,适用于涉及足前部的足背中、大面积皮肤软组织缺损的修复.     

应用胸背动脉穿支带蒂皮瓣修复前臂残端创面的初步报告

目的 总结胸背动脉穿支带蒂皮瓣修复前臂残端创面临床应用结果. 方法 2001年9月至2006年5月,应用胸背动脉穿支带蒂皮瓣修复5例同侧前臂残端软组织缺损.其中男4例,女1例,年龄20～44岁(平均37岁).右侧3例,左侧2例.皮瓣切取范围:30 cm×9 cm～40 cm×9 cm,平均34 cm×9 cm. 结果 1例术后发生小的受区切口表浅感染,经换药逐渐愈合,改良的穿支皮瓣全部成活,术后经过顺利,随访1.5～5.0年,平均2.8年.受区外形满意,没有发现明显的供区功能障碍,取得了较满意的效果. 结论该皮瓣以胸背动脉穿支为血供,具有血供丰富,血管解剖恒定,血管蒂长以及皮瓣较薄等优点,带蒂移植适宜修复同侧前臂软组织缺损.     

The distally based island posterior interosseous flap

The posterior interosseous vessels give a significant contribution to the fascial plexus which supplies the skin of the forearm. This vascular arrangement forms the basis for an island fasciocutaneous flap which can be based either proximally or distally. Twenty-two dissection studies have been carried out to demonstrate the vascular anatomy of the posterior interosseous artery and its contribution to the fascial plexus. Based on this information, the design and usage of an island fasciocutaneous flap is described. A distally based island fasciocutaneous flap appears to have a reliable vascular basis and its role in covering soft tissue defects in the hand is illustrated in three clinical cases.     

The distally based lateral sural neuro-lesser saphenous veno-fasciocutaneous flap: anatomical basis and clinical applications

Background

Soft tissue management around the lower third of the leg and foot presents a considerable challenge to the plastic surgeon. The aim of this research was to investigate the anatomical relationships of artery, nerve, vein and other adjacent structures in the posterolateral region of the calf, and our experience with using a distally based island flap pedicled with the lateral sural nerve and the lesser saphenous vein for soft tissue reconstruction of lower third of leg, foot, and ankle defects in 15 patients.

Materials and methods

Five fresh cadavers (ten lower limbs) were infused with colored red latex. The origin of the nutrient vessel of the lesser saphenous vein and the lateral sural nerve was identified. Based on the anatomical studies, an island flap supplied by the vascular axis of the lesser saphenous vein and the lateral sural nerve was designed for clinical reparative applications in 15 cases.

Results

The nutrient vessel of the lesser saphenous vein and the lateral sural nerve originates from the superficial sural artery, musculocutaneous perforators of the posterior tibial artery, and septocutaneous perforators of the peroneal artery in different segment of the calf. Meanwhile, these vessels have many sub-branches nourishing subcutaneous tissue and skin, form a favorable vascular chain around the nerve and the vein, and also communicate with vascular plexus of superficial and deep fascia. Among 15 flaps, 13 showed complete survival (86.66 %), while marginal flap necrosis occurred in one patient (6.67 %) and distal wound dehiscence in another (6.67 %). Their appearance and function were satisfactory, with feeling maintained in the heel and lateral side of the foot.

Conclusions

The distally based flap pedicled with the lateral sural nerve and lesser saphenous vein was a reliable source for repairing soft tissue defects in the lower leg and foot due to its advantages of infection control, high survival rate, and sufficient blood supply without the need to sacrifice a major blood vessel.