以骨间后血管为蒂的前臂后侧皮神经营养血管皮瓣在手部创伤修复中的应用

Posterior neurocutaneous vascular axial flap pedided with distal segment of the posterior interosseous artery in the forearm for repairing defects of the hand

目的报告应用改进前臂后侧皮神经营养血管逆行皮瓣的手术方法及临床效果。方法设计以骨间背侧血管下段为蒂的前臂后侧皮神经营养血管皮瓣逆向转位修复手腕背以远的皮肤缺损创面。临床应用22例，皮瓣最远修复至近侧指间关节，皮瓣最大切取面积为14cm×10cm，蒂部最长12cm。结果术后22例皮瓣全部存活，未发生血管危象。随访时间为6～12个月，皮瓣质地优良，外形与功能恢复满意。结论经改进后的前臂后侧皮神经营养血管皮瓣可用于修复手部较大面积的皮肤软组织缺损。

Objective To report the surgical techniques and clinical results of modified posterior neurocutaneous vascular axial flap in the forearm. Methods A reversed posterior neurecutaneous vascular flap in the forearm pedicled with distal segment of the posterior interosseous artery was designed to repair skin defects in the hand caused by high energy injuries. Tweney-two patients with skin defect distal to the dorsal wrist were treated with this flap. The distal-most defect was at the proximal interphalangeal joint. The largest flap measured 14 cm × 10 cm. Tile longest pedicle was 12 cm. Results All flaps were transferred successfully without necrosis. There was no vascular crisis. Postoperative follow up ranged from 6 to 12 months. The flaps had good texture and consistency. Hand function and appearance were satisfactory. Conclusion Modified reverse posterior neurecutaneous vascular flap in the forearm can overcome limitations in harvest area and rotation distance by the conventional flap,making it suitable for repairing large skin and soft tissue defects in the hand.