前臂背侧皮动脉逆行岛状皮瓣的解剖与应用

The anatomy and the use of reverse island flap pedicled with antebrachial cutaneous branch of the posterior interosseous artery

目的改进切取前臂骨间背侧动脉逆行岛状皮瓣的手术方法。方法新鲜成人上肢标本20侧,对前臂骨间背侧动脉及其皮支进行解剖测量。临床应用前臂骨间背侧皮动脉逆行岛状皮瓣治疗创面26例,男20例,女6例;年龄16～62岁,平均32岁。损伤情况:机器挤压伤14例,皮肤撕脱伤10例,电击伤1例,烧伤1例。损伤部位:手背20例,虎口3例,拇指背侧1例,腕屈侧2例。转位皮瓣最大面积为14cm×9cm,最小面积为6cm×8cm。供区全厚皮片植皮。结果在尺侧腕伸肌和小指伸肌的腱腹交界区域有恒定的前臂背侧皮动脉存在,前臂背侧皮动脉距尺骨茎突(9.24±1.33)cm,直径(0.70±0.15)mm。据此设计了前臂背侧皮动脉的逆行岛状皮瓣,并应用于临床,26例全部成活。术后22例未使用扩血管药物;2例使用扩血管药物6h后皮瓣下出现张力血肿,清理血肿并停用扩血管药物后,皮瓣成活;2例术后4h皮瓣苍白,使用扩血管药物后皮瓣成活。术后随访6周～1年,皮瓣良好。26例均未发生静脉血管危象。皮瓣游离后,供区功能未受到明显影响。结论游离包含前臂背侧皮动脉的皮瓣使切取前臂骨间背侧动脉逆行岛状皮瓣的手术简便、快捷、安全、有效。

Objective To improve the surgical procedure of antebrachial flap with a pedicle of the posterior interosseous artery. Methods Twenty fresh upper extremity specimens were taken to make an anatomic measurement of the posterior interosseous artery and its cutaneous branchs. 26 cases of the soft tissue defects of the dorsum of the hand, the webbed space between thumb and the index as well as the palmar wrist region were repaired. There were 14 machinery compressive injuries, 10 lacerated injuries, and 1 each of electric shock injury and burn. The area of wound was 6 cm×8 cm to 14 cm×9 cm, the donor flap was of full-thickness. Results A stable cutaneous branch of the posterior interosseous artery in the interspace of the belly and tendon of extensor carpi ulnaris and extensor digiti minimi was always found. It lay (9.24±1.33) cm above styloid process of ulna, its diameter was (0.70±0.15) mm. Depending on it, a flap of skin pedicled with cutaneous branch of the posterior interosseous artery could be designed. The transfer of flaps of all 26 cases survived, no vessel dilating drugs were administered in 22 cases, in 2 cases, the flaps became pale and hematoma occurred 4 hs after operation, but survived after debridement and the use of vessel dilating drugs. No any vascular crisis was found, and after the freeing of flaps, it exhibited no any effect on donor site. Conclusion The use of reverse island flap pedicled with cutaneous branch of the posterior interosseous artery is convenient and makes an earlier recovery, it is also safe and effective.