尺动脉近侧穿支蒂前臂内侧皮神经营养血管皮瓣修复肘部皮肤缺损

Medial forearm pedicled neurocutaneous flap from perforators of proximal ulnar artery repairs defect of soft tissue around the elbow:report of 12 cases

目的探讨尺动脉近侧穿支蒂前臂内侧皮神经营养血管皮瓣对肘部皮肤缺损修复的可行性。方法2006年1月至2008年12月,采用尺动脉近侧穿支蒂前臂内侧皮神经营养血管皮瓣转移修复肘部创面患者12例,年龄20～52岁。7例单纯皮肤缺损,5例伴有骨外露,2例伴尺神经缺损。神经缺损采用游离腓肠神经移植桥接,皮肤软组织缺损范围约4.0cm×5.0cm～6.0cm×8.0cm。供区游离植皮。结果12块皮瓣全部存活,皮瓣范围5.0cm×6.0cm～7.0cm×9.0cm。8例获随访(包括电话随访)1个月至2年,皮瓣色泽、质地与外形良好,肘关节可自由活动。2例尺神经缺损病例随访6～10个月,爪形手畸形明显改善。结论尺动脉近侧穿支蒂前臂内侧皮神经营养血管皮瓣可修复肘部皮肤缺损,血供可靠,手术操作简单。

Objective To explore the feasibility of repairing the defect of soft tissue around the elbow with the medial forearm pedicled neurocutaneous flap from the perforators of proximal ulnar artery. Methods From January 2006 to December 2008, 12 patients, aged from 20 to 52 suffering from defect of soft tissue around the elbow received a repairing by the pedicled neurocutaneous flap. There were 7 cases of defects of simply soft tissue, 5 cases of bone exposed, and 2 cases of ulnar nerve defect, which were bridged by sural nerve. The defect of soft tissue was ranging from 4.0 cm× 5.0 cm to 6.0 cm ×8.0 cm. The donor sites of flaps were repaired with skin grafting. Results All the flaps were primarily survived. The area of the flap was from 5.0 cm × 6.0 cm to 7.0 cm×9.0 cm. Among these patients, 8 were followed up （ including through telephone） for 1 month to 2 years. During the follow-up, the color, texture and appearance of the flaps were good. The elbow exercised freely. The claw hands deformity of 2 defects of ulnar nerve were improved in 6 to 8 months after operation. Conclusion The medial forearm pedicled neurocutaneous flap from the perforators of proximal ulnar artery can repair the defect of soft tissue around the elbow, with reliable blood supply and simple operative procedure .