游离桡侧副动脉穿支皮瓣移植的临床应用经验

Clinical Application Experience of Free Radial Collateral Artery Perforator Flaps

目的总结游离桡侧副动脉穿支皮瓣移植修复四肢皮肤软组织缺损和手足部复合组织缺损的临床应用经验。方法临床应用37例游离桡侧副动脉穿支皮瓣修复四肢皮肤软组织缺损和手足部复合组织缺损,其中单一穿支皮瓣24例,多叶皮瓣1例,嵌合肌瓣3例,嵌合骨瓣6例,嵌合肌瓣和骨瓣3例。皮瓣最大面积为16 cm×7 cm,最小为4 cm×3 cm。皮瓣供区保留深筋膜和主要的浅静脉,尽量直接缝合。皮下脂肪肥厚的皮瓣切取后以穿支为中心进行阶梯状修薄。结果 37例穿支皮瓣完全成活,创口一期愈合,仅1例皮瓣后期因为反复溃烂予以切除。随访4～26个月,皮瓣血运良好,质地比较薄而柔软,外形良好,9例应用骨瓣修复的骨折愈合时间3～7月,平均4.2月。全部皮瓣供区直接闭合,供区损害很小。结论游离桡侧副动脉穿支皮瓣质地比较薄、外形美观、设计灵活、供区损伤小、可以吻合皮神经重建感觉、可以嵌合切取小块骨瓣和肌瓣,是修复四肢中小面积皮肤软组织缺损和手足部复合组织缺损的理想皮瓣之一。

Objective To summarize the clinical application experience of free radial collateral artery perforator flaps for repairing soft tissue defects in limbs and complex tissue defects in the hands and feet. Methods 37 free radial collateral artery perforator flaps were applied to repair soft tissue defects in limbs and complex tissue defects in the hands and feet. Of all flaps ,24 were single perforator flaps, 1 was polyfoliate flap, 3 were chimeric muscle flaps, 6 were chimeric bone flaps ,3 were chimeric muscle and bone flaps. The sizes of dissected flaps ranged from 16 cm x 7 em to 4 em x 3 cm. Deep fascia and major superficial vein were reserved in the donor sites, and the donor sites were sutured directly as far as possible. After cut,the fat flaps were thinned down step by step centering on perforator pedicles. Results 37 flaps sur- vived completely and the wound healed primarily, but one was excised finally because it ulcerated repeatedly in later period. The following-up of the flaps ranged from 4 months to 26 months. All flaps were characterized by rich blood supply, and they were relatively thin, and had soft texture and satisfactory appearance. Bone union in 9 cases repaired with chimeric bone flaps took from 3 to 7 months （ average 4.2 months）. The donor sites of all flaps were sutured directly, and the damage to do- nor sites was very small. Conclusion The free radial collateral artery perforator flap is one of ideal options for repairing soft tissue defect in limbs with medium or small area and complex tissue defect in the hand and foot, because it has so many advantages such as relative thinness, soft texture, satisfactory appearances, flexible design, less damage to donor site, reconstruction of sensation by anastomosing cutaneous nerve and cutting-out of chimeric muscle and bone flap with small size.