前臂桡神经浅支营养血管皮瓣的临床应用

Clinical applications of superficial radial nerve nutrient vessel flaps in the forearm

目的总结前臂桡神经浅支营养血管皮瓣逆行转移修复手部软组织缺损的临床效果。方法1999年6月至2010年12月，应用前臂桡神经浅支营养血管皮瓣逆行转移修复15例手部皮肤软组织缺损。以前臂桡神经浅支走行线作为皮瓣的轴线设计皮瓣，深筋膜下锐性分离，逆行转移覆盖创面，如需重建感觉功能，可将皮瓣上携带的皮神经与受区皮神经相缝合。结果术后15例中，2例皮瓣远1／3部分皮下淤血，其中1例皮瓣尖端约1．5cm×1．0cm坏死，经换药后愈合；其余皮瓣均顺利存活。术后随访4个月至8年，皮瓣外形及功能满意。结论该皮瓣切取简单，外观好，对供区损伤小，转移随意性强，可重建感觉功能，并与受区皮肤颜色近似，是修复手背、手掌及虎口部皮肤软组织缺损较为理想的方法之一。

Objective To summarize the clinical results of retrograde transfer of forearm superficial radial nerve nutrient vessel flaps to repair skin and soft tissue defects in the hand. Methods From June 1999 to December 2010, forearm superficial radial nerve nutrient vessel flaps were retrogradely transferred to cover soft tissue defects of the hand in 15 cases. The projection of the course of superficial radial nerve in the forearm was used as the axis of the flap. The flap was designed along the axis and dissected sharply beneath the deep fascia. It was then rotated distally to reach the defects in the hand. If a sensate flap was needed, the cutaneous nerve included in the flap was coapted to the cutaneous nerve of the recipient site. Results Of the 15 flaps, 2 suffered from subcutaneous blood stasis in the distal 1/3 of the flap. Skin necrosis of 1.5 cm×1.0 cm at the tip of the flap was debrided and healed after dressing changing in one case. The rest of the flaps survived uneventfully. The appearance and function of the flaps were satisfactory through 4 months to 8 years of follow-up. Conclusion This flap is easy to harvest, causes minor donor site morbidity, offers flexible transfer options and can be transferred as a sensate flap. It has good appearance with matching skin color of the recipient site. It is an ideal method in the repair of soft tissue defects of the palm, dorsum of the hand and the first web space.