桡侧蒂旋转推进筋膜皮瓣修复前臂皮瓣供区缺损

目的探讨桡侧蒂旋转推进筋膜皮瓣关闭前臂皮瓣切取术后供区缺损的可行性与临床应用价值。方法2014年11月-2015年5月采用桡侧蒂旋转推进筋膜皮瓣对36例患者行桡侧前臂皮瓣切取后的供区缺损进行修复。其中男性28例,女性8例。年龄28~67岁,平均年龄53.6岁,皮瓣大小为3.0 cm×5.0 cm~4.0 cm×6.0 cm。术后定期随访,对切口愈合、瘢痕增生及前臂外观等情况进行记录和评价。术后3个月和6个月分别测量腕关节的掌屈、背伸、尺偏、桡偏角度,计算腕关节失能指数,并与术前对比,评估腕关节功能恢复状况。采用SPSS 19.0统计软件包中的配对t检验进行统计学分析。结果36例患者前臂皮瓣切取后产生的供区创面均采用桡侧蒂旋转推进筋膜皮瓣顺利关闭而无需植皮。其中5例患者术后因切缘张力过大发生缺血性改变,表皮剥脱后色素丧失,但切口愈合未受影响。术后随访6~12个月期间,所有患者前臂切口均未见明显瘢痕增生,外观满意。术后3个月和6个月,患者腕关节的掌屈、背伸、尺偏、桡偏角度及腕关节失能指数与术前比较差异无统计学意义（P>0.05）。结论应用桡侧蒂旋转推进筋膜皮瓣能够直接关闭中小型前臂皮瓣切取后供区缺损,术后外观满意且不会对腕关节功能产生不良影响,值得临床推广应用。     

前臂桡侧游离皮瓣在口腔颌面外科的应用——附725例临床分析

目的详细阐述前臂桡侧游离皮瓣的应用解剖、制作技术、在口腔颌面外科的应用及新近研究进展。方法对我科自１９７９年以来，７２５例应用前臂桡侧游离皮瓣修复口腔颌面部各类缺损的病例，进行了临床分析。结果前臂桡侧游离皮瓣质地优良、血供可靠已及切取方便，总成功率达９６．６％；主要缺点是牺牲前臂的一条主供血管—桡动脉，供区疤痕明显，影响美观。结论前臂桡侧游离皮瓣是口腔颌面外科应用最多皮瓣，也是修复口腔颌面部软组织缺损的首选皮瓣。     

前臂桡侧皮瓣与股前外侧皮瓣修复半舌缺损的比较研究

目的：分析比较前臂桡侧皮瓣与股前外侧皮瓣在修复半舌缺损后的舌功能恢复和供受区并发症情况。方法：2008年7月-2012年11月,23例舌癌患者接受肿瘤扩大切除,遗留的半舌缺损,14例采用前臂桡侧皮瓣修复,供区伤口取腹部全厚皮片移植修复;9例采用股前外侧皮瓣修复。术后4~6个月,对每例患者的吞咽功能、语言清晰度和供受区并发症等情况进行随访分析。结果：前臂桡侧皮瓣组和股前外侧皮瓣组患者吞咽功能和语言清晰度均恢复良好,两组之间无显著差异。在受区,前臂桡侧皮瓣组有1例出现全部皮瓣坏死;股前外侧皮瓣组有1例出现小部分皮瓣坏死,1例出现口颈瘘。在供区,前臂桡侧皮瓣组有4例出现移植皮片部分坏死,1例伤口部分裂开,12例出现明显的瘢痕,9例局部麻木,3例手臂功能障碍;股前外侧皮瓣组有1例局部麻木,1例出现明显的瘢痕,均未出现运动功能障碍。前臂桡侧皮瓣组供区并发症明显多于股前外侧皮瓣组。结论：股前外侧皮瓣可获得的血管蒂长、管径大、供区并发症少,是半舌缺损较理想的修复组织瓣。     

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。     

张力对改良前臂皮瓣供区恢复的影响

目的探讨张力对改良前臂皮瓣(使用前臂供区皮片关闭前臂术创)供区恢复的影响。方法对2018年10月至2021年4月于徐州市中心医院就诊的12名经前臂皮瓣修复的口腔癌患者,术前记录患者双手握力及腕关节活动度,前臂供区关创,使用前臂供区的三角形全厚皮片关闭部分术创,另一部分术创直接拉拢缝合,供区关创时用拉力计测量张力。术后对患者进行随访,观察患者术后供区创口有无坏死、愈合不良等并发症及供区侧前臂握力及腕关节活动度、外形满意度。结果 12例患者中仅1例高龄患者术后供区皮片近腕侧坏死情况,该患者平均张力为0.65 kg,经换药后二期愈合;其余患者术后供区未出现并发症。12例患者平均张力大小为(0.51±0.05)kg。12例患者术前术后握力分别为(23.7±10.3)kg、(22.3±10.7)kg,差异无统计学意义(t=5.872,P<0.001);术前术后腕关节活动度分别为掌屈(47.6±8.3)°、(45.8±5.8)°;背伸(54.6±3.2)°、(53.9±2.3)°;桡偏(37.0±2.3)°、(36.1±2.2)°;尺偏(27.1±1.9)°、(26.4±1.3)°。四个方向...     

两种术式前臂皮瓣术后前臂供区恢复的比较

目的:比较两种类型的前臂皮瓣桡侧术后前臂供区恢复的情况.方法:回顾我院44例因口腔颌面部肿瘤致术后缺损经游离前臂皮瓣修复的患者.皮瓣由同一经验丰富的医师制取.按照制取皮瓣的方法分为传统的前臂皮瓣(A组),以下简称传统组,改良的前臂皮瓣(B组),以下简称改良组,对其术后半年、术后1年进行随访,针对制取皮瓣的手术时间、皮片...     

前臂桡侧游皮瓣在口腔颌面外科的应用

目的 详细阐述前臂桡侧游离皮瓣的解剖、制作技术、在口腔颌面上科的应用及新近研究进展。方法 对我科自１９７９年以来，７２５例应用前臂桡侧游离皮瓣修复口腔颌面部各类缺损的病例，进行了临床分析。结果 前臂桡侧游离皮瓣持地优良、血供可靠已及切取方便，总经达９６．６％；主要缺点是牺牲前臂的一条主供血和桡动共区疤痕明显，影响美丽。结论 前臂桡侧游离皮瓣是口腔颌 科应用最多皮瓣，也是修复口腔颌面部软组织损的首皮     

适形前臂桡侧皮瓣修复面颊部软组织缺损的效果评价

目的：评价适形前臂桡侧皮瓣游离移植修复面颊部不规则皮肤软组织缺损的临床效果。方法：选择2020年1月—2021年12月徐州市中心医院收治的面颊部外伤或肿瘤导致的不规则皮肤软组织缺损患者9例,设计个性化、适形前臂桡侧皮瓣游离修复缺损区,观察患者术后短期内皮瓣修复效果及患者满意度,应用抑郁自评量表(self-rating depression scale,SDS)及焦虑自评量表(self-rating anxiety scale,SAS)评估患者手术前后心理状态。采用SPSS 20.0软件包对数据进行统计学分析。结果：术后皮瓣均顺利存活,术后2周患者SDS评分、SAS评分显著低于术前(P<0.05)。8例患者的皮瓣与周围皮肤组织厚度、色泽无明显差异,无牵拉及不对称,外观与功能修复效果满意,满意度为88.89%。结论：利用适形前臂桡侧皮瓣游离修复面颊部不规则软组织缺损效果良好,术后短期内患者焦虑和抑郁评分改善明显,满意度高,值得临床应用。     

36例带血管蒂前臂桡侧皮瓣制备之体会

前臂桡侧皮瓣是口腔颌面外科医师在肿瘤切除后的修复手术中常选用的一种皮瓣。皮瓣制备之优劣直接关系到修复手术的成功与否。作者于1987～1990年，在上海市第九人民医院口腔颌面外科参加了36例前臂桡侧皮瓣制备手术，成功34例，失败2例。现就制备中的经验教训和体会报告如下。临床资料本组制备36例前臂桡侧皮瓣，共35例病员，男性13例，女性22例；年龄13～76岁，中位年龄为47岁。其中舌癌18例，颊癌7例，口底癌／2例，牙龈癌2例，血管瘤2例，咽侧壁恶性肿瘤2例，其他2例；皮瓣面积最大为15cmX7．5cm，最小为5cmX4cm；供区选于左侧21例，右…     

对偶三角瓣联合原位小面积全厚皮片修复前臂游离皮瓣供区缺损

目的: 介绍一种对偶三角瓣联合原位小面积全厚皮片修复前臂游离皮瓣供区缺损的方法。方法: 对25例口腔鳞癌患者行前臂游离皮瓣修复肿瘤切除术后缺损,在制备前臂游离皮瓣的同时,进行供区对偶三角瓣及邻近小面积全厚皮片的设计和制取,原位修复供区缺损。结果: 25例前臂供区缺损均成功采用供区对偶三角瓣联合原位小面积全厚皮片修复。用于关闭前臂供区缺损的邻近全厚皮片均存活,创口愈合良好,无迟发性创面破裂,未发生供区严重并发症。取瓣侧手臂肘腕关节运动正常,掌部血运正常,前臂皮瓣供区缺损修复区域与周围组织皮肤色泽接近,无凹陷畸形,无挛缩畸形。与腹部取皮组相比,前臂邻近皮片修复组在术后肿胀和腕关节运动没有明显差异的情况下,瘢痕感染几率减少,肌腱外露风险降低,大大提高了前臂术区的美观性。结论: 改良供区对偶三角瓣联合邻近全厚皮片修复技术减少了术中和术后恢复时间,避免第三术区的创伤,值得在临床上应用。     

Blood flow monitoring by pulse oximetry during a forearm flap elevation

The Allen's test for blood flow is performed before a forearm flap is elevated to examine vascularization through the ulnar artery. In this study, to ensure the survival of the donor site when a forearm flap was elevated, we monitored patients using a pulse oximeter. From oral cancer patients who were undergoing reconstructive surgery using the forearm flap, twenty patients were randomly selected to be served as subjects. A pulse oximeter probe was attached to the thumb on the side from which a skin flap was to be elevated. Oxygen saturation was measured when the tourniquet was released, and the radial artery was clamped and severed. The results showed that oxygen saturation temporarily decreased when the radial artery was ligated, but it recovered in one to two minutes.     

Free flap monitoring using simultaneous non-invasive laser Doppler flowmetry and tissue spectrophotometry.

BACKGROUND: Early identification of flap failure is an indispensable prerequisite for flap salvage. Although many methods of free flap monitoring are available, there is still no single reliable non-invasive technique for early recognition of flap failure and for differentiation between arterial occlusion and venous congestion. The aim of this study was to investigate the benefits of the tissue oxygen analysis system O(2)C for monitoring patients undergoing maxillofacial reconstruction with fasciocutaneous radial forearm flaps. MATERIAL AND METHODS: In a prospective clinical study the microcirculatory parameters of blood flow, flow velocity, haemoglobin concentration (AU, Arbitrary Units) and oxygen saturation (%) were assessed by clinical means, by laser Doppler flowmetry and tissue spectrophotometry in 61 patients intraoperatively. Measurements were carried out before flap harvest, in the separated radial forearm flap, immediately after anastomoses and up to 14 days after reconstruction. RESULTS: Following anastomosis, blood flow and flow velocity exceeded the level before flap elevation and reached significant differences by the third postoperative day (p<0.05). Oxygen saturation decreased significantly by the third postoperative day and haemoglobin oxygenation showed stable values after performing anastomosis. Simultaneous, non-invasive laser-Doppler flowmetry and tissue spectrophotometry detected vascular complications in all cases with no false positive or false negative results and prior to clinical assessment. CONCLUSION: For the first time this new device allows reliable prediction of venous congestion by an increase of haemoglobin-concentration, and of arterial occlusion by a decrease in blood flow parameters and oxygen saturation. It can thus differentiate the mechanisms of flap failure before clinical assessment.     

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。     

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.     

前臂游离全厚皮片修复前臂游离皮瓣供区缺损的临床观察

目的:观察同侧前臂局部全厚皮片修复前臂游离皮瓣切取后供区缺损的临床效果。方法:27例口腔鳞癌患者,所取前臂皮瓣最小为5cm×6cm,最大为6cm×9cm。前臂皮瓣取下后,按设计在前臂近心端切取三角形不含皮下组织的全厚皮片。关闭伤口时,从近心端向远心端进行,一直到术前设计时指定的一点,剩余三角形区域用切取的全厚皮片覆盖。结果:所有患者移植皮片成活良好,并且获得良好的外观。结论:本方法所植皮片的颜色与周围正常皮肤组织接近,不增加创伤,不增加并发症,不影响功能,具有一定的优势。     

Closure of radial forearm free flap donor site with local full-thickness skin graft.

A triangular shaped full-thickness skin graft harvested adjacent to the donor site of the radial forearm flap, as originally described by Liang et al, has successfully been used in seven consecutive patients for coverage of the donor site of the radial forearm free flap. In all patients this resulted in a robust coverage with no late wound breakdown and an aesthetic appearance far superior to split-thickness skin-graft coverage. We recommend this technique which is feasible in the majority of cases and reduces both donor site and graft site morbidity of the radial forearm flap.     

Changes of perfusion of microvascular free flaps in the head and neck: a prospective clinical study

Reconstruction with a free flap is routine in head and neck surgery. However, reliable assessment of perfusion can be difficult, so we prospectively evaluated it in 4 types of microvascular free flaps in the oral cavity (n = 196) and assessed differences in blood flow by non-invasive monitoring with a laser Doppler flowmetry unit. We measured oxygen saturation, haemoglobin concentration, and velocity on the surface of the flap preoperatively at the donor site, and on the flap on the first, second, and seventh postoperative days, and after 4 weeks in 186/196 patients, mean (SD) age of 60 (13) years. We studied the radial forearm (n = 76, 41%), fibular (n = 45, 24%), anterolateral thigh (n = 53, 28%), and soleus perforator (n = 12, 7%) flaps. The values for the radial forearm flap differed significantly from the others. There were significant differences in haemoglobin concentrations between the fibular and soleus perforator flaps, and between the anterolateral thigh and soleus perforator flaps (p = 0.002 each). Free flaps are unique in the way that perfusion develops after microvascular anastomoses. Knowledge of how each flap is perfused may indicate different patterns of healing that could potentially influence long term rehabilitation and detection of future deficits in perfusion.     

Complications and Outcome of Free Flap Transfers for Oral and Maxillofacial Reconstruction: Analysis of 213 Cases

Microvascular free flap transfers have become a preferred reconstructive technique; however, rare complications may still prove devastating. This study reviewed 213 consecutive freetissue transfers in order to assess the incidence and causes of complications in patients undergoing microvascular free flap reconstruction in the oral and maxillofacial region. In most cases, reconstruction was undertaken after resection of a malignant tumor. The flap donor sites were the radial forearm (n=111), rectus abdominis (n=88), scapula (n=13), and latissimus dorsi (n=1). The superior thyroid artery and the external jugular vein were commonly used as recipient vessels for anastomosis. The overall flap success rate was 99%. There were 7 cases of postoperative vascular thrombosis (6 venous and 1 arterial), constituting 3.3% of the entire series. Five flaps were salvaged, representing a 71.4% successful salvage rate in cases of vascular complications. Most of the successful salvage attempts were made within 24 hours of the end of the initial operation, and the successful salvage rate for re-exploration was 100%. Finally, the total flap loss rate was 0.9% and the partial flap loss rate was 2.3%. We conclude that early re-exploration should be the first choice for management of vascular compromised flaps. Complications at the donor site occurred in 17 cases (8.0%), the most common complication of which was partial skin graft loss after harvesting a radial forearm flap (n=10; 9.0%). Recipient and donor site morbidity was limited and considered acceptable.