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。

Rotation and advancement of the radial-based fasciocutaneous flap for primary closure of the radial forearm flap donor defect

Objective This study aims to investigate the feasibility and clinical application value of a new method for primary donor-site closure of radial forearm flaps with the use of rotation and advancement of radial-based fasciocutaneous flaps. Methods The forearm donor-site defects of 36 patients were primarily closed by rotation and advancement of radialbased fasciocutaneous flaps after radial flap harvest from November 2014 to May 2015. Patients included 28 males and 8 females aged 28 to 67 years (53.6 years old on average). Flap size ranged from 3.0 cm×5.0 cm to 4.0 cm×6.0 cm. Wound healing, scar hyperplasia, and forearm appearance were recorded and evaluated. Wrist flexion angle, dorsal extension angle, ulnar deviation angle, and radial deviation angle were measured three and six months after the operation. Wrist joint loss index was calculated and compared with the preoperative index to evaluate wrist function recovery. The results were subjected to comparative t test to perform statistical analysis with SPSS 19.0 statistical software package. Results Forearm donor sites were successfully closed without skin grafting in all patients. Skin ischemia caused by excessive tension was observed at the incision edge in five cases, thereby leading to skin exfoliation and pigment loss without affecting wound healing. All patients were followed up at six and twelve months, and presented a satisfactory appearance. No scar hyperplasia was observed. No significant difference was observed in radial deviation, ulnar deviation, palmar flexion, dorsiflexion, radial deflection angle, or wrist joint loss index (P>0.05) after the operation. Conclusion Application of rotation and advancement of radial-based fasciocutaneous flaps can directly close small-to-medium radial forearm flap donor defects. Satisfactory postoperative appearance can be achieved with no loss in wrist joint function. The novel method prove worthy of promotion and application in clinical work.