桡侧副血管蒂前臂外侧皮瓣的解剖学基础

目的 :为桡侧副血管蒂前臂外侧皮瓣移植提供解剖学依据。方法 :在 45侧灌注红色乳胶的成人上肢标本上观察了桡侧副动脉的来源、走行及其在肘关节部位的分支、分布和吻合。结果 :桡侧副动脉在距肱骨外上髁 ( 7.7±1.0 )cm处分为掌侧支和背侧支 ,背侧支在肱骨外上髁上方 ( 1.4± 0 .3 )cm处分为前支和后支 ,前支跨越肘关节到达前臂 ,以 2～ 4个皮支分布于前臂外侧的皮肤 ,其分支点外径为 ( 0 .8± 0 .2 )mm ,前支在桡骨颈平面和桡侧返动脉相吻合的占72 % ,可切取的皮瓣面积约 15cm× 5cm。结论 :以桡侧副动脉为蒂的前臂外侧皮瓣转位可修复肘部、上臂和颈部的软组织缺损 ,亦可吻合血管游离移植修复手、足部和面颈部的软组织缺损 ,还可形成臂外侧下部、前臂外侧大型皮瓣或复合组织瓣 ,修复大面积的软组织缺损。     

The Evolution of the Pedicled Radial Forearm Flap

Because of the thin skin envelope of the hand, especially at the dorsum, flaps are frequently required for defect reconstruction in the hand. The pedicled radial forearm flap is a time proven procedure that offers reliable coverage in this area without the need of advanced microsurgical expertise. Despite several alternatives and an increasing acceptance of free tissue transfers, the pedicled radial forearm flap can still be the procedure of choice under special circumstances. Variations of the original technique address the two main disadvantages, the conspicuous donor site and the sacrifice of the radial artery. Indications, anatomy, surgical technique, and limitations of this classic workhorse flap are presented.     

Cephalic Vein-Pedicled Radial Forearm Semi-free Flap: An Alternative When no Suitable Vein in Recipient Site for Free Forearm Flap

The risk of venous thrombosis is the main factor of free forearm flap necrosis. In some cases there is no suitable vein at recipient site to provide venous return of the free flap. In this report, two cephalic vein-pedicled radial forearm semi-free flaps were used as an alternative to resurface soft tissue defects in submaxilla and anterior cervical area. The two flaps survived uneventfully. The cephalic vein-pedicled radial forearm semi-free flap could be harvested with a long cephalic vein pedicle, and could be an alternative when there was no suitable or healthy recipient veins at recipient site.     

腓肠神经营养血管筋膜蒂皮瓣修复跟骨骨折外侧入路术后软组织缺损

目的探讨腓肠神经营养血管筋膜蒂皮瓣治疗跟骨骨折外侧人路术后软组织缺损的临床疗效。方法2011年1月至2012年5月,采用腓肠神经营养血管筋膜蒂皮瓣修复38例跟骨骨折外侧入路术后软组织缺损患者。腓肠神经与足背外侧皮神经相吻合重建皮瓣的感觉功能。结果所有患者皮瓣均完全成活．受区创口以及皮瓣供区切口均I期愈合,无1例患者出现术后血管危象。经6～18个月随访,皮瓣质地柔软、弹性好,无臃肿,外形满意,皮瓣两点辨别觉6．5-11mm。结论本方法操作简便、血运可靠,术后外观及功能恢复满意,值得临床推广应用。     

Incidentaloma at Radial Artery Forearm Free Flap Harvest: An Occult Volar Wrist Ganglion

Occult volar wrist ganglion originating from radioscaphoid interval and having adherence to flexor carpi radialis tendon [Fcr] and radial artery is an uncommon occurrence. We report such a case which was occult and asymptomatic during pre-operative assessment and presented as an incidentaloma during radial artery forearm free flap harvest for oral cancer reconstruction.     

Superficial Circumflex Iliac Artery Perforator Flap with Bilobed Design for the Donor Defect after Wrap‐Around Flap Transfer Reconstruction

ObjectiveThe repair of great toe donor site defect after wrap‐around flap transfer is still controversial. The bilobed superficial circumflex iliac artery perforator (SCIP) flap can improve the aesthetics of the great toe while maintaining its function. Thus, this study aimed to report our experience in the reconstruction of big toe donor site defects with the bilobed SCIP flap and describe the clinical outcomes.MethodsThis study was a retrospective trial. From May 2017 to May 2020, 13 patients with the great toe donor site defect after wrap‐around flap transfer were included in this study. The average age of the patients was 44 years (range, 23–60 years). All patients received free bilobed SCIP flaps to reconstruct the donor site defect of the great toe. Relevant clinical features were recorded preoperatively. The thickness and design of the SCIP flap and the harvesting layer of the flap were measured during the operation. The survival rate of flaps and skin grafts and the incidence of infection were recorded after operation. At follow‐up, donor site complications and postoperative outcomes were evaluated.ResultsIn all cases, the SCIP flap covering the donor site of the great toe survived. All patients were followed up for 24–40 months (mean, 30.5 months). The average thickness of the SCIP flap was 0.38cm. All SCIP flaps were harvested from the superficial fascial layer except for three obese patients. The thin SCIP flap had a bilobed design with no further defatting procedures. Postoperatively, the great toe‐nail flap donor site regained its original appearance without bloating or flap necrosis. There was a hidden linear scar in the groin donor site, which did not affect hip joint movement. All patients were satisfied with the aesthetics of the surgical site.ConclusionThe SCIP flap with bilobed design for repairing the donor defect of the great toe after wrap‐around flap transfer is a kind of surgical method with excellent contour, meeting the requirements of function and aesthetics.     

Radial Artery Harvest Using the Sharp Scissors Method for Patients with Pathological Findings on Allen's Test

Purpose The pathological findings on Allen's test tend to be contraindicative for radial artery (RA) harvest. However, the employment of a meticulous harvest technique might help protect the collateral vessels from the interosseous arteries and thus help to maintain forearm circulation. We herein report successful RA harvest using the sharp scissors method in patients with pathological findings on Allen's test. Methods Ten patients with pathological findings on Allen's test underwent RA harvest using only sharp scissors and metal clips. The distal end of the RA was left approximately 5 cm from the wrist. Using forearm thermography, the skin temperature of the harvest site was compared with that of the nonharvest site. All patients underwent postoperative forearm angiography one month after surgery. Results No ischemic events in the forearm or harvest site complications were observed. Thermography showed no difference in the skin temperatures between the harvest and nonharvest sites in all patients. Moreover, forearm angiography 1 month postoperatively showed that the interosseous arteries to be well developed and connected to the distal end of the RA in all patients. Conclusions These results suggest that a meticulous RA harvest using sharp scissors and clips can help to protect from collateral perfusion of the interosseous arteries. Using this method, RA harvest is therefore considered to be acceptable even for patients with pathological findings on Allen's test.     

手前臂复合软组织缺损修复与异体肌腱移植功能重建

目的 探讨手及前臂复合软组织缺损的修复与功能重建.方法 2001年5月～2005年10月,对18例前臂及手部复合软组织缺损患者一期采用胸腹部带蒂皮瓣修复缺损创面,二期采用肌腱移位加多条同种异体肌腱移植重建伤手功能,皮瓣最大为39cm×12cm,异体肌腱移植最多6条.结果 术后18例皮瓣均成活,皮瓣外形好,异体肌腱移植效果满意,伤手功能恢复良好,部分患者伤肢功能完全恢复.结论 胸腹部带蒂皮瓣加多条同种异体肌腱移植修复手及前臂复合软组织缺损具有损伤小、皮瓣外形好、方法简便、伤手功能满意等特点.     

采用耳后筋膜瓣行鼻尖塑形

目的探讨在硅胶假体隆鼻同时,取耳后筋膜行鼻尖塑形的方法。方法在37例鼻部整体塑形手术中,应用开放式切口,充分剥离鼻翼软骨,向上提拉重塑鼻翼软骨最高点,并取部分耳后筋膜缝合于"L"型假体鼻尖处,整体植入。结果 37例受术者切口均Ⅰ期愈合,无感染、鼻尖頂出等并发症,鼻部整体塑形效果良好,受术者鼻尖高度明显增加。结论应用耳后筋膜结合硅胶假体可有效提高鼻尖鼻背高度,是塑造鼻部整体外形的较好方法。     

The First Case of Free Radial Forearm Skin Flap: A 40-Year Follow-Up Study

BackgroundThe radial forearm skin flap (RFSF) was first introduced by the Chinese scholar Guofan Yang and has since been used for nearly 40 years. The many advantages of RFSF have been investigated in this study.Case presentationIn this case, a female patient underwent RFSF surgery in 1979. In 2016 and 2018, two interviews were held to evaluate her subjective postoperative experience. In addition, overall donor site evaluation was conducted based on general health checkups and tests; tests for appearance, tactile sensitivity, muscle strength, and motor function; and CTA.ResultsThe flap survived well, and the donor site recovered without hand necrosis in the 1970s. In 2018, the patient was in good health condition and expressed her satisfaction with the surgery. The patient did not suffer from any postoperative complications such as diminished sensation of the donor site or donor site dysfunction; in the evaluation of hand and finger function, there was no point where functional reduction of the donor site was noted. CTA revealed compensatory blood supply with enlargement in the diameter of the ulnar and interosseous artery.ConclusionAfter a nearly 40-year follow-up, the patient who underwent the first free radial forearm flap transplantation expressed satisfaction with the operative outcomes. The examination showed good results at the recipient site with little donor site deformities and good compensatory blood supply.     

跖底动脉皮瓣逆行转移修复趾皮肤缺损

目的探讨趾外伤或再造后皮肤缺损使用带蒂皮瓣修复的临床应用价值。方法 2003年9月～2009年9月用跖底动脉皮瓣逆行转移修复趾皮肤缺损21例。在足底设计以跖底动脉为蒂的跖底动脉皮支穿出点为中心的逆行皮瓣修复趾皮肤缺损,设计的跖底皮瓣宽度均小于3cm,供区可以直接缝合。再造时足部供区切取的面积较大,用跖底皮瓣修复趾骨外露创面,其余部分配合植皮。结果 21例跖底动脉皮瓣全部成活,8例外伤和4例Ⅰ度指尖缺损再造的趾供区直接用跖底皮瓣修复,9例拇甲瓣供区配合植皮。供区修复后外形良好,不需要二期整形。结论跖底动脉皮瓣逆行转移修复趾皮肤缺损,皮瓣薄、有神经支配、解剖位置恒定,是修复趾端小面积皮肤缺损的好方法。     

应用胸脐皮瓣治疗前臂瘢痕

目的 :前臂瘢痕切除后 ,为创面修复提供简单、理想的治疗方法。方法 :8例前臂增生和疙瘩瘢痕患者 ,瘢痕切除后皮肤缺损面积最大 2 5cm× 13cm ,最小 16cm× 6cm。应用胸脐皮瓣转移或移植修复 (转移者 6周后断蒂 ) ,其中 3例采用转移 ,5例行移植。结果 :皮瓣全部成活 ,经随访 5～ 16个月 ,修复部位厚薄适中 ,与周边皮肤色泽相符 ,外观满意。结论 :该术式修复前臂瘢痕切除后遗留创面较为理想 ,操作简单 ,具有推广应用价值。