以上臂外侧穿支为蒂的V-Y推进皮瓣修复肘背部较小创面

目的探讨以上臂外侧穿支为蒂的V-Y推进皮瓣修复肘背部纵向缺损距离<3.5 cm的较小创面的方法及疗效。方法 2008年3月-2010年8月,收治6例肘背部较小创面患者。男4例,女2例;年龄16～76岁,平均53岁。碾压伤3例,冲床伤2例;受伤至入院时间4 h 30 min～7 d,平均29.5 h。肘背部慢性感染1例,病程12个月。创面范围为4.0 cm×2.5 cm～9.5 cm×3.5 cm,均伴有骨或肌腱外露。采用大小为6.0 cm×4.0 cm～12.5 cm×9.5 cm的以上臂外侧穿支为蒂的V-Y推进皮瓣移位修复肘背部缺损。供区直接拉拢缝合。结果术后6例皮瓣完全成活,创面Ⅰ期愈合;供区切口Ⅰ期愈合。患者均获随访,随访时间6～12个月。皮瓣外形无臃肿,质地、颜色与周围组织相似。末次随访时皮瓣两点辨别觉为12～16 mm。肘关节活动无障碍,屈伸活动度95～125°,平均105°。结论以上臂外侧穿支为蒂的V-Y推进皮瓣手术操作简便、对供区影响小,是修复肘背部较小创面的较好方法之一。

V-Y advancement of skin flap pedicled with upper limb lateral branch for small skin defect in the dorsal elbow

Objective To research the method and effectiveness of V-Y advancement of skin flap pedicled with the upper limb lateral branch in the treatment of small skin defect in the dorsal elbow.Methods Between March 2008 and August 2010,6 cases of skin defect in the dorsal elbow were treated by V-Y advancement of skin flap pedicled with the upper limb lateral branch,including 4 males and 2 females with a mean age of 53 years(range,16-76 years).Defects were caused by crushing in 3 cases,by punching in 2 cases,and the disease duration was 4 hours 30 minutes to 7 days(mean,29.5 hours);and by chronic infection in 1 case,and the disease duration was 12 months.The defect size ranged from 4.0 cm × 2.5 cm to 9.5 cm × 3.5 cm,all complicating by bone or tendon exposure.The flap size ranged from 6.0 cm × 4.0 cm to 12.5 cm × 9.5 cm;the donor sites were sutured directly.Results All flaps survived completely,wounds and incisions at donor sites healed by first intention.Six cases were followed up 6-12 months after operation.The flaps had good texture and color.Two-point discrimination of the skin flap was 12-16 mm.The function of limb was normal,and elbow flexion and extension activity averaged 105°(range,95-125°).Conclusion It is ideal to treat small skin defect in the dorsal elbow with V-Y advancement of skin flap pedicled with the upper limb lateral branch because of easier operation and less injury at donor site.