游离上臂外侧皮瓣在手部皮肤缺损中的应用

Application of free lateral arm flap in repairing skin defects of the hand

目的探讨应用游离上臂外侧皮瓣修复手部中小面积软组织缺损的方法和临床效果。方法2007年10月-2008年4月，对14例手部皮肤缺损患者，应用游离上臂外侧皮瓣进行修复。以桡侧副血管为蒂重建皮瓣血供，以皮神经重建感觉，皮肤缺损面积为5．0cm×4．0cm．9．0cm×5．5cm。血管采用端端或端侧吻合法。结果术后皮瓣全部存活。无血管危象发生。术后随访时间为3～8个月，3例皮瓣略臃肿（2例手背皮瓣3个月后行整形手术），皮瓣外观及弹性良好，感觉恢复至S3～S4。结论以桡侧副血管为蒂的上臂外侧皮瓣血管解剖恒定，皮肤穿支丰富，感觉重建满意，是修复手部中小面积皮肤缺损的有效方法。

Objective To explore the surgical technique and clinical outcomes of applying free lateral arm flap to repair skin defects in the hand of small to medium size. Methods From October 2007 to April 2008. 14 cases of skin defects of the hand were treated. The lateral arm flap was harvested for free transfer. The nutritional artery was the radial collateral artery. Cutaneous nerves were included in the flap and repaired to restore sensation. The size of the skin defects ranged from 5.0 cm × 4.0 cm to 9.0 cm × 5.5 cm. According to diameter of the pedicle artery, blood vessels were anastomosed either in an end-to-end or an end-to-side fashion. Results All the transferred free flaps survived uneventfully. No vascular crisis happened postoperatively. All cases were followed up for 3 to 8 months. Bulkiness was noticed in 3 flaps （2 of which were flaps at the dorsum of the hand that underwent surgical debulking 3 months later）. The overall appearance and texture of the flaps were good. Sensory recovery reached S3 to S4. Conclusion The lateral arm flap based on the radial collateral artery has constant vascular anatomy and rich cutaneous perforators. When the cutaneous nerve is repaired, sensory recovery is satisfactory. It is an effective procedure to repair small to medium size skin defects of the hand.