上臂远端外侧肱骨骨皮瓣修复手部复合组织缺损

目的 探讨上臂远端外侧肱骨骨皮瓣在手外科的临床应用效果.方法 对8例手部复合组织缺损的患者,根据掌指骨缺损的情况,先设计骨瓣的切取位置和大小(骨瓣远端止于肱骨外上髁的上缘),然后再根据皮肤缺损的面积和骨缺损的相对位置设计皮瓣的大小.前臂后皮神经位于皮瓣的中轴线上,可以保留或一并切取使用,恢复受区感觉.皮瓣切取面积为4.0cm×8.0cm～6.0cm×8.0cm,骨瓣切取大小为4.0cm×1.5cm×1.0cm～6.0cm×1.5cm×1.0cm.结果 术后8例骨皮瓣全部存活,上臂供区创面直接闭合,愈合好,上臂功能无影响.术后随访4～24个月,皮瓣感觉恢复良好,移植骨完全愈合,手部外形满意.结论 上臂远端外侧肱骨骨皮瓣是修复手部创面和掌、指骨复合组织缺损的理想选择.

Reconstruction of complex tissue defects of the hand with humeral osteocutaneous lateral arm flap

Objective To investigate the clinical effect of the application of humeral osteocutaneous lateral arm flap in reconstruction of complex tissue defects of the hand. Methods Eight cases of complex tissue defects of the hand were treated. The location and size of the bone flap was designed first according to the defect of the metacarpal and phalangeal bones (the distal end of the bone flap was at the upper margin of the lateral epicondyle). Then the location and size of the cutaneous flap was designed according to the defects of the hand. The line between the insertion of deltoid muscle and the epicondylus lateralis humeri is the body projection of the posterior branch of radial collateral artery. It is the axis while designing the flap. The posterior antebrachial cutaneous nerve can be retained in the flap in order to restore sensation of the recipient site. The area of the skin flaps ranged from 4.0 cm× 8.0 cm to 6.0 cm× 8.0 cm, while the area of the bone flaps ranged from 4.0 cm× 1.5cm×1.0cm to 6.0cm×1.5cm×1.0cm. Results All 8 osteocutaneous flap survived uneventfully.The donor sites were closed directly in all 8 cases. Functions of the upper arm were not impaired. The patients were follow-up for 4 to 24 months. Flap sensation recovery was satisfactory. Bone healing was observed and hand appearance was satisfactory. Conclusion The humeral osteocutaneous lateral arm flap is ideal for reconstruction of complex tissue defects of the hand.