远端为蒂的前臂背侧皮下筋膜瓣修复手背软组织缺损

Soft-tissue Defect Coverage on the Dorsum of Hands with Distally Based Dorsal Forearm Fasciosubcutaneous Flap

目的总结远端为蒂的前臂背侧皮下筋膜瓣移植修复手背软组织缺损伴骨或肌腱外露的临床应用结果。方法自2009年1月至2013年1月,应用远端为蒂的前臂背侧皮下筋膜瓣移植修复手背软组织缺损伴骨或肌腱外露10例（男8例,女2例）。患者年龄20~49岁（平均29.8岁）。损伤后至手术时间3 h至28 d,平均18 d。皮下筋膜瓣表面行一期中厚网状游离植皮,供区直接缝合。结果 1例受区发生小的皮缘裂开,术后2周自然愈合,2例发生小块植皮坏死再次行中厚植皮修复愈合。皮下筋膜瓣全部成活,所有患者术后随访1.5~3.0年（平均2.5年）。受区外形较好。结论这种技术很适宜手背软组织缺损伴骨或肌腱外露的修复,操作安全可靠,减轻了对供区的损伤。

Objective To summarize clinical application results of the repair soft tissue defects with exposure of bonds or tendons on the dorsum of hands with distally based dorsal forearm fasciosubcutaneous flap transplantation. Methods From January 2009 to January 2013,10 patients（ 8 men,2 women） with soft-tissue defect on the dorsum of hands underwent reconstruction with distally based dorsal forearm fasciosubcutaneous flap transplantation（ without microvascular anastomoses）. They ranged in age from 20 to 49 years（ mean 29. 8 years）. The operative time after injury was from 3 hours to 4 weeks（ mean 18days）. The immediate coverage of the fasciosubcutaneous flaps were performed by a meshed splitthickness skin graft. The donor site was closed directly. Results One case in them,recipient area edge developed small wound dehiscence,which spontaneous heal 2 weeks after surgery. Two cases that developed minimal skin graft loss were treated successfully with a subsequent split-thickness skin graft. All the fasciosubcutaneous flaps had survived completely. Follow-up period ranged form 1. 5 to 3years（ mean 2. 5 years） postoperatively. A good contour was confirmed at the recipient area. Satisfactory clinical results were obtained in all cases. Conclusion Distally based dorsal forearm fasciosubcutaneous flap is particularly useful the repair soft tissue defects with exposure of bonds or tendons on the dorsum of hands. This technique is safe and reliable and minimal donor site lesion.