带感觉的上臂外侧皮瓣游离移植修复手部皮肤缺损

Free lateral arm neurocutaneous flap for reconstruction of skin defects of hand

目的游离上臂外侧穿支感觉皮瓣修复手部皮肤缺损。方法2008年7月-2010年5月．急诊或择期行同侧上臂外侧穿支感觉皮瓣修复手部皮肤缺损11例．其中单纯皮肤缺损5例．合并肌腱伤或骨折6例。皮瓣切取面积为6．5cm×4．5cm-11cm×6．5cm，皮瓣包括上臂外侧皮神经．移至受区重建皮瓣感觉。结果术后皮瓣全部成活。随访5～12个月．皮瓣外观及弹性良好，单纯皮肤缺损行皮瓣移植后手部各关节主被动活动正常者5例，合并肌腱伤或骨折行皮瓣移植后手部各关节主动活动有不同程度影响者6例。按中华医学会手外科学会断指再植功能评定标准评定：优7指，良4指。结论带感觉上臂外侧皮瓣游离移植是修复手部皮肤缺损的一种较好方法。

Objective To expore the surgical method and chnical outcome of applying free lateral arm perforating neurocutaneous flap in repairing skin defects of hand. Methods From July 2008 to May 2010, 11 patients in whom skin defects of hand were reconstructed with lateral arm perforating neurocutaneous flap i acute or selective stage from the same arm of the injured hand. The sizes of the harvested flaps ranged from 6.5cm×4.5cm to 11cm×6.5cm. Cutaneous nerves were included in the flap to restore sensation. Blood vessels and nerves were anastomosed in an end-to-end fashion. Results 11 transplanted lateral arm flaps in 11 patients were all survived completely, They were followed up from 5 to 19 months, with an average of 9 months. The overall appearance and texture of the transferred flaps were good and had good appearance. According to the upper limb functional evaluation criteria issued by the Branch of the Hand Surgical of the Chinese Medical Association：excellent in 7, good in 4. All passive and active motions of＇joints were normal in 5 cases with skin defects only,however ,active motions were sacrified to some extend in 6 cases with tendon injury or fracture. Conclusion The lateral arm perforating neurocutaneous flap based on the radial collateral artery may be a valuable option as a flap for skin defects of hand.When the cutaneous nerve is repaired, sensory recovery is satisfactory.