带尺动脉腕上皮支的不同蒂皮瓣临床应用

浙江湖州市第一医院骨科夏增兵、王丹、袁永健来稿:分别选用以尺动脉腕上皮支主干--升支为蒂皮瓣、尺动脉腕上皮支降支--升支为蒂皮瓣、尺动脉远端一腕上皮支升支为蒂皮瓣,修复手部软组织缺损共18例.术中腕上皮支降支为蒂或主干升支为蒂的皮瓣切取时可带入2～3 cm宽筋膜蒂,保留浅层的筋膜血管网.修复手掌创面时,需于受区找到可供吻合神经与前臂内侧皮神经缝接.     

显微外科花絮

带尺动脉腕上皮支的不同蒂皮瓣临床应用 浙江湖州市第一医院骨科夏增兵、王丹、袁永健来稿：分别选用以尺动脉腕上皮支主干——升支为蒂皮瓣、尺动脉腕上皮支降支——升支为蒂皮瓣、尺动脉远端-腕上皮支升支为蒂皮瓣，修复手部软组织缺损共18例。术中腕上皮支降支为蒂或主干升支为蒂的皮瓣切取时可带入2—3cm宽筋膜蒂，保留浅层的筋膜血管网。修复手掌创面时，需于受区找到可供吻合神经与前臂内侧皮神经缝接。结果1例皮瓣远端部分坏死，1例表皮坏死脱落、色素沉着，其余皮瓣均成活良好，皮瓣外观、质地满意。     

游离尺动脉腕上皮支下行支皮瓣的临床应用

目的 介绍游离尺动脉腕上皮支下行支皮瓣修复手部创面的手术效果。方法 对47例手部软组织缺损的患者，采用以尺动脉腕上皮支下行支为血管蒂的游离皮瓣进行修复。结果 术后46例皮瓣全部成活，1例皮瓣远端部分坏死．经植皮后愈合。术后随访6～18个月，皮瓣质地、外形满意，两点分辨觉为6～9mm。结论 应用尺动脉腕上皮支下行支皮瓣修复手部创面．血管解剖较恒定，操作简便，值得临床推广应用。     

尺动脉腕上皮支下行支筋膜皮瓣的应用

目的 探讨尺动脉腕上皮支下行支筋膜皮瓣修复手部尺侧软组织缺损的临床意义.方法 对10例手部尺侧软组织缺损的患者,应用尺动脉腕上皮支下行支筋膜皮瓣进行修复.皮瓣切取面积为2.5 cm×1.5 cm～ 4.5 cm× 2.0 cm.结果 术后10例皮瓣全部存活,随访6～ 18个月,皮瓣色泽、质地恢复满意.供区创面均Ⅰ期愈合,无明显功能障碍,外观瘢痕不明显.结论 与其他传统带蒂或游离皮瓣相比,尺动脉腕上皮支下行支筋膜皮瓣是一种较理想的修复方法.     

尺动脉腕上皮支及下行支筋膜皮瓣修复手部创面的临床应用

目的探讨带尺动脉腕上皮支及下行支的筋膜皮瓣修复手部创面的临床疗效。方法对24例手部皮肤软组织缺损患者采用带尺动脉腕上皮支及下行支的筋膜皮瓣逆行转移修复;其中手掌尺侧缺损创面6例,手背尺侧3例,环指掌侧5例,小指掌侧4例,环指背侧3例,小指背侧3例;急诊一期手术19例,手部瘢痕挛缩二期手术修复5例。结果24例皮瓣全部成活。患者均获得随访,时间3～36（12±3）个月,修复后的皮瓣质地、外形满意,无色素沉着,13例修复感觉神经者两点分辨觉为6～9mm;5例瘢痕挛缩者手部屈曲挛缩解除,手指主被动活动度得到明显改善。结论应用带尺动脉腕上皮支及下行支的筋膜蒂皮瓣修复手部缺损创面解剖较恒定,操作简便,成活率高,值得临床推广。     

前臂非主要血管逆行岛状皮瓣修复手部创面

前臂非主要血管逆行岛状皮瓣修复手部创面邢更彦，姚建祥１９８８年以来，应用前臂非主要血管—骨间背侧动脉及尺动脉腕上皮支动脉为蒂的前臂逆行岛状皮瓣修复手部创面１３例，其中应用前臂骨间背侧动脉皮瓣９例，尺动脉腕上皮支皮瓣４例。１３例中，修复拇指、２～５指毁...     

选择性应用游离尺动脉腕上皮支皮瓣修复手指皮肤缺损

以尺动脉腕上皮支为蒂的前臂尺侧皮瓣移位修复手部皮肤缺损,在国内首先由张高孟等[1]报告.随后,以其为供血动脉的游离皮瓣移植修复手部皮肤缺损的临床应用口益增多[2,3].但对如何选择性应用尺动脉腕上皮支上行支皮瓣和下行支皮瓣的研究较少.2004年2月至2007年8月,我们根据上、下行支的解剖关系以及手指皮肤缺损面积的大小,分别采用游离尺动脉腕上皮支上行支皮瓣和下行支皮瓣对12例手指皮肤缺损患者创面进行移植修复,获得了满意的效果,现报告如下.     

尺动脉腕上皮支筋膜皮瓣修复手部软组织缺损

目的 探讨尺动脉腕上皮支筋膜皮瓣修复手部软组织缺损的临床意义。方法 选择本院收治的20例手部软组织缺损患，应用尺动脉腕上皮支筋膜皮瓣修复，术后观察皮瓣的血运、色泽、质地及感觉的恢复。结果 术后20例全部成活，随访3—4个月，皮瓣的色泽、质地及感觉恢复均满意，两点辨别觉为10mm—15mm。供区创面一期修复愈合，无功能障碍。结论 与其他传统皮瓣修复相比，尺动脉腕上皮支皮瓣是一种较理想的修复方法^[1,2]。     

尺动脉腕上皮支皮瓣修复手部皮肤软组织缺损

目的探讨尺动脉腕上皮支皮瓣修复手部皮肤软组织缺损的疗效。方法2006年8月-2010年5月应用尺动脉腕上皮支皮瓣修复手部皮肤软组织缺损16例。结果16例皮瓣全部成活，其中1例远端部分皮肤出现暗紫、水疱，予以换药表层脱痂愈合。12例获3～12个月随访，皮瓣色泽、质地均较满意。结论应用尺动脉腕上皮支皮瓣修复手部软组织缺损疗效满意。     

尺动脉腕上皮支皮瓣修复手部创面

采用尺动脉腕上皮支为蒂的前臂尺侧岛状皮瓣修复手部创面８例，６例全部成活，２例部分成活。介绍了皮瓣的实用解剖，手术方法和主要优点。该手术的特点是在腕上不切断尺侧腕屈肌和贵要静脉，在尺动脉上皮支周围保留１．５ｃｍ宽的筋膜蒂，其内含有细小血管，这样使皮瓣血供更加充分。     

尺动脉腕上皮支皮瓣修复手掌软组织缺损

目的探讨尺动脉腕上皮支皮瓣修复手掌软组织缺损的疗效。方法应用尺动脉腕上皮支皮瓣修复17例17块手掌皮肤软组织缺损。结果17块皮瓣全部成活,其中2例远端部分皮肤出现暗紫、水疱,予以换药表层脱痂愈合。15例获随访,时间5个月～3年,皮瓣色泽、质地均较满意,掌指关节伸屈活动范围0°～85°,虎口区角度50°～60°,拇指对掌功能恢复良好。结论应用尺动脉腕上皮支皮瓣修复手掌软组织缺损疗效满意。     

Clinical study of dorsal ulnar artery flap in hand reconstruction

Soft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft.     

Preliminary report: the distally pedicled dorsoulnar forearm flap for hand reconstruction.

In this paper, a new flap for the coverage of soft tissue defects in the hand is described. To obtain a distally pedicled dorsoulnar flap, the dissection of the standard dorsoulnar flap is continued distally under the descending branch of the dorsal branch of the ulnar artery onto the dorsum of the wrist after the dorsal branch of the ulnar artery is ligated and divided. Our modification of the standard dorsoulnar flap converts this flap to a distally based flap, which provides a potentially longer pedicle and increases the arc of rotation of the flap. Two successful cases are reported.     

改良的尺动脉腕上皮支皮瓣修复手掌软组织缺损

目的　探讨经改良的尺动脉腕上皮支皮瓣修复手掌软组织缺损的方法。　方法　根据尺动脉腕上皮支及前臂内侧皮神经的走行设计改良皮瓣 ,于腕上皮支起点的近端 1cm处结扎并切断尺动脉 ,形成以尺动脉携腕上皮支和前臂内侧皮神经为蒂的改良皮瓣。 1997年 8月～ 2 0 0 1年 11月 ,用此皮瓣修复手掌软组织缺损 15例 ,其中急诊手术7例 ,择期手术 8例 ,皮瓣范围 7cm× 5 cm～ 12 cm× 8cm。　结果　术后随访 3周～ 6个月 ,15例皮瓣全部成活 ,皮瓣远端无缺血、坏死 ,外观及功能满意。　结论　改良的尺动脉腕上皮支皮瓣的血管蒂长、血供丰富、具有感觉 ,可修复手掌任何部位的缺损 ,且手术操作简便易行。     

以骨间前动脉及背侧支为蒂组织瓣的临床应用

目的报道以骨间前动脉及背侧支为蒂组织瓣移位术的手术方法。方法临床设计以骨间前动脉及背侧支为蒂的组织瓣共20例；其中逆行岛状皮瓣4例，逆行岛状骨瓣4例，顺行岛状骨瓣2例，逆行岛状骨膜瓣2例，逆行岛状骨皮瓣8例。应用组织瓣修复手背、虎口皮肤缺损，修复掌骨缺损、尺骨骨不连、月骨无菌性坏死等。结果11例皮瓣和骨皮瓣全部成活，1例皮瓣远端部分坏死，经植皮后愈合。术后随访3个月～4年，受区移植骨全部骨性愈合，手部功能满意。结论以骨间前动脉及背侧支为蒂的组织瓣可设计成多种类型，是修复手及前臂复合组织缺损的良好供区。     

以掌背动脉为蒂尺骨远段背侧骨瓣移位术的应用解剖

目的 为以掌背动脉为蒂的尺骨远段背侧骨瓣移位修复第３、４、５掌骨头缺损提供解剖学依据。方法 在３０侧成人上肢标本上解剖,观察腕背动脉网的构成及分支。结果 腕背动脉网由桡动脉及尺动脉腕背支及与骨间后动脉终末支,骨间前动脉腕背支吻合形成,由该网发生第２、３、４掌背支,第２、３、４掌背动脉由掌背支与掌深弓所发深支吻合而成。结论 以第３、４掌背动脉为蒂的尺骨远端背侧半片骨瓣,可修复第３、４、５掌骨头缺损。     

The ulnar artery forearm free flap

The ulnar artery forearm flap is a reliable, versatile and convenient fasciocutaneous flap. Based on the ulnar artery distal to the common interosseous branch it may include muscle (FCU) tendon (PL) and bone (ulna). The arterial and venous anatomy allow a flow-through capability and a reversal of flow which permits its use as a distally pedicled island flap. Many of its properties are shared with the radial flap, but the ulnar flap has further advantages. The donor site is virtually hairless, easily closed even when bone is taken, and is less obvious as it lies on the proximal ulnar aspect of the forearm. The ulnar artery is not reconstituted and in 11 cases there has been no clinical evidence of any circulatory, sensory or motor impairment of the hand. The flap is especially useful in intra-oral reconstruction and has been valuable in the lower leg where it may restore deficient distal circulation.     

桡动脉腕背分支为蒂的手背逆行岛状筋膜皮瓣的临床应用

目的探讨手背部桡动脉腕背分支为蒂的三种逆行岛状筋膜皮瓣的手术方法及临床应用。方法桡动脉在腕背鼻烟窝穿出,与尺动脉掌深弓吻合之前,发出腕背皮支、第1掌背动脉、拇指背侧支以三支动脉为蒂,形成逆行鼻烟窝皮瓣、第1掌背动脉皮瓣、拇指背侧动脉皮瓣,修复虎口挛缩和指、示指、腕掌、腕背侧皮肤缺损。结果切取桡动脉腕背皮支逆行岛状皮瓣13例,修复拇指、虎口、指、腕掌、腕背组织损伤及缺损。术后随访皮瓣外形及手功能恢复效果满意。结论桡动脉腕背分支行岛状筋膜皮瓣血运好,质地柔软,切取方便,不牺牲主要动脉,是修复手部皮肤缺损的一种简单安全、损伤小的方法。     

Treatment of complex hand trauma using the distal ulnar and radial artery perforator-based flaps

SUMMARY: The clinical value of distal ulnar or radial artery adipofascial perforator flaps is shown in a series of 30 patients with severe hand and wrist injuries and major soft tissue defects requiring coverage. There were 22 men and 8 women, aged 16-73 years. The defects were dorsal and/or palmar, with or without transpalmar or transcarpal amputation, or amputation of the thumb and/or the digits. Tendon injuries have been treated primarily or secondarily, or reconstructed using silicon rods. In all cases, after surgical debridement of the wound, reconstruction of the defect was done using distal ulnar (21 patients, in 3 patients primary reconstruction) and distal radial artery (11 patients; in 2 patients primary reconstruction and in 2 patients after necrosis of distal ulnar perforator flap) adipofascial perforator flaps. Minimum follow-up was 6 months. Two ulnar flap showed partial necrosis and were revised successfully by distal radial adipofascial perforator flaps. One radial and one ulnar flap showed 50% and 60% necrosis, respectively, and were revised by groin flaps. All donor sites healed uneventfully. Functional and cosmetic result was very good in 15 patients and good or satisfactory in the remaining. Range of motion of the wrist and hand joints was almost within normal limits (less than 25 degrees extension or flexion deficits). Distal ulnar and radial artery adipofascial perforator flaps for traumatic defects of the hand and wrist offer several advantages compared to other local flaps; they are easy to obtain and cover effectively both dorsal and palmar defects without significant functional deficits or donor site complications to the upper limb.