供区免植皮的游离前臂皮瓣技术在头颈肿瘤修复中的运用

Modified Free Radial Forearm Flap without Grafting in the Reconstruction of Post-operative Defects of Head and Neck Cancer

目的:介绍一种头颈肿瘤手术中游离前臂皮瓣供区时采用邻近双叶瓣替代游离植皮的技术。方法:在制备游离前臂皮瓣同期取前臂皮瓣缺损区域的临近尺侧双叶瓣修复缺损,避免前臂皮瓣供区植皮。双叶瓣大叶用于修复前臂皮瓣的供区缺损,其面积为前臂皮瓣供区缺损的80%。小叶用于修复大叶,其面积为大叶的50%。结果:全部13例前臂皮瓣成活,无皮瓣坏死,头颈部缺损均获得I期关闭和愈合。前臂供区均采用I期临近双叶瓣修复,两例患者出现瘀斑和水泡,经处理后均未影响双叶皮瓣的存活。所有患者前臂肘关节及腕关节运动正常,无受限。结论:改良的供区不植皮的前臂皮瓣制备技术减少了术后和供区并发症的发生,临近双叶皮瓣的运用避免了植皮带来的外形及功能影响,值得在头颈肿瘤前臂皮瓣修复中应用推广。

To describe a technique modification for radial forearm free flap （RFF） raising and direct closure of the forearm donor site. Methods： RFFs were harvested as rhomboid, with the long axis centered on the radial artery in 13 patients with head and neck squamous cell carcinoma. A bilobed rhomboid flap was designed adjacent to the donor defect. After raising the RFFs, the wounds were closed primarily without tension. Results： All 13 RFF and bilobed rhomboid flaps survived completely, and the donor sites healed primarily without any skin graft or major complication. Ecchymosis and blisters occurred in two bilobed rhomboid flaps, which did not affect the survival of the flaps. The post-operative movement of wrist was as normal as the opposite wrist. Conclusion： RFFs are harvested as rhomboids, with their long axis centered on the radial artery, ensuring radial forearm flap viability. The direct closure of donor site of RFF by bilobed rhomboid flap without skin grafting increases the aesthetic and functional outcomes of patients.