骨间后血管及其返支为蒂串连皮瓣的临床应用

目的为手部皮肤软组织缺损探寻一种新的修复方法.方法在40侧人体上肢标本上,对骨间后血管及其返支的来源、走行、分支、分布及吻合情况进行解剖观察的基础上,设计以前臂骨间后血管及其返支为蒂的串连皮瓣.1998年8月～2000年7月间临床应用此皮瓣逆行移位修复手背远侧及手指背侧皮肤缺损17例.皮瓣范围最大15cm×10cm,最小7cm×5cm.结果术后随访3周～6个月,除1例皮瓣远端有2cm×3cm坏死外,其余皮瓣全部成活,外观及功能满意.结论此皮瓣不损伤肢体主要血管,血管蒂较长,皮瓣切取面积较宽,厚薄适中,可用于修复拇指、手背至手指近节背侧的皮肤软组织缺损.手术简便,效果良好.

CLINICAL APPLICATION OF THE SERIAL FLAP PEDICLED WITH POSTERIOR INTEROSSEOUS ARTERY AND ITS RECURRENT BRANCH

OBJECTIVE: To explore a new surgical approach to repair skin and soft tissue defect of hands. METHODS: Based on the anatomical study of the origin, course, branch, distribution, and anastomosis of the posterior interosseous artery and its recurrent branches in 40 upper limbs of cadavers, the posterior forearm serial flap, pedicled with the posterior interosseous artery and its recurrent branches, was designed and applied clinically in 17 cases to repair the skin and soft tissue defect of hands from August 1998 to July 2000. The size of flaps ranged from 7 cm x 5 cm to 15 cm x 10 cm. All of the cases were followed up for 3 weeks to 6 months. RESULTS: The anatomy study showed that the posterior forearm serial flap had long vascular pedicle, suitable thickness and large skin area. The clinical application indicated that the flaps survived in 16 cases. But flap necrosis at the distal end, sized 2 cm x 3 cm, was observed in one case, in which the defect was repaired by delayed skin grafting, CONCLUSION: The posterior forearm serial flap pedicled with the posterior interosseous artery and its recurrent branch have the character of avoidance of sacrificing the major arteries of the extremity, longer vascular pedicle, larger area and suitable thickness. The posterior forearm serial flap is a safe and easily manipulated surgical approach to repair the skin and soft tissue defect of the hands, especially of the thumb, palm, and proximal part of the fingers.