四肢皮神经营养血管皮瓣的临床应用

Clinic application of neurocutaneous vasular flap of extremities

目的 报道四肢皮神经营养血管皮瓣临床应用的效果。 方法 用带桡神经拇背尺侧支,前臂外侧皮神经前支营养血管逆行岛状皮瓣及第一掌背皮神经逆行岛状筋膜瓣修复拇指、手背、手腕部软组织缺损10例;用腓肠神经营养血管逆行岛状皮瓣修复胫前区,踝部及足背软组织缺损4例;用隐神经营养血管皮瓣游离移植修复腕掌部软组织缺损1例,皮瓣最大面积18cm×10cm。 结果 15例中10例完全成活,5例均因静脉回流障碍皮瓣远端部分坏死,但皮下组织均成活,经植皮而愈,经随访皮瓣的质地、外观及功能尚好。 结论 此类皮瓣动脉血供可靠,不损伤主干血管,有的具有重建感觉的条件,可顺、逆行移位,损伤较小,操作简单,有些部位可进行远位游离移植,应用得当,效果满意。但静脉回流障碍的防治、蒂的长度与皮瓣成活面积的关系尚待进一步研究。

Objective To report the clinic result of nuerocutaneous vascular flap for reconstruction of skin and soft tissue defect of extremities Methods The reverse island flaps based on the thumb ulnar dosal branches of the radial nerve or the anterior branches of the lateral forearm cutaneous nerve or the first dorsum of plama branch of radial nerve for the reconstruction of the skin and soft tissue defect on the thumb,dorsal of the palma or wrist were used in 10 cases Retrograde flow island sural neurocutaneous vascular flap were applied to repair the soft tissue defect on the anterior area of tibialis or malleolus or dorsum of foot in 4 cases A free saphenous nerve vascular flap was applied to repair the soft tissue defect of the wrist and palma,the size of this flap was 18 cm×10 cm Results Fifteen cases,10 cases were survived completely;distal part of flap were necrosis partly in 5 cases because of vein drainage disturbance,but the subcutaneous tissue under the necrosis were alive and healed by skin graft Follow up,the texture,appearance and function of the flap were good Conclusion Flaps of this kind have advantages as follow:the reliable blood supply,avoidance of sacrificing the major arteries,reconstruction of sensation,simply procedure,lesser injuries for donor area,reverse or anterograde flow transfer,even free transplantation It can get satisfactory result with application properly The prevention and management of disturbance of vein drainage,relationship between the length of pedicle and survived size of flap will be investigated further