胫后动脉内踝上皮支血管蒂球拍状岛状皮瓣的临床应用

Clinical application of free upper limb lateral bone-skin flap in hand surgery field

目的报道胫后动脉内踝上皮支为血管蒂岛状皮瓣修复足及小腿皮肤软组织缺损的临床应用及疗效。方法在小腿内侧以胫后动脉内踝皮支为血管蒂设计成球拍状岛状皮瓣修复足及小腿皮肤软组织缺损17例,其中交腿皮瓣修复5例。球拍(皮瓣)面积为16cm×9 cm～6 cm×4 cm,在小腿中上段设计切取,球拍柄宽2 cm,长为4～12 cm,在小腿中下段内侧设计切取。结果17例皮瓣术后血运好,无肿胀、淤血,全部成活,随访皮瓣质软,外形美观,供区均一期愈合,疗效满意。结论皮瓣设计灵活,血运可靠,切取方便,不损伤胫后动脉,是修复足及小腿皮肤软组织缺损的理想皮瓣。

Objective To report the surgical method and treatment outecome of transfer of free upper limb lateral bone-skin flap for repair of bone defects and nonunion in hand and forearm. Methods 17 cases of hand composite trauma, 5 cases of forearm composite trauma and 2 cases of nonunion in forearm were treated with free bone-skin flaps in distal humerus, whose pedicle was the posterior branch of radical collateral artery. Area of the flap was 2cm × 3cm to 8cm × 10cm, length of exsected bone was 3 - 6 cm. Results All the bone-skin flaps completely survived, the donor area all achieved primary healing, On postoperative 1 -4 years follow-up, the texture of the flap was excellent, and bone union was obtained in all transplants, the donor area of distal lateral humerus became thicker and thicker with new cortical bones formed. According to the upper arm function assessment criterion issued by hand surgery association of Chinese medical association. The hand function had excellent results in 17 cases and good results in 2 cases. Conclusion The bone-skin flap has following advantages ： easy dissection, reliable blood supply, and no major vessel needed to be sacrificed, so it is an effective method for repair of skin and soft tissue with bone defects in hand and forearm, It.also can be used to repair refractory nonunion in ulna and radius.