前臂Kiss皮瓣设计及其应用价值探讨

Kiss flap design of radial forearm flap for primary closure of donor-site without skin-grafting

目的:对传统前臂皮瓣制备实施改进,寻求符合几何原则的供区直接关闭而免于植皮的制备方法。方法:13例口腔癌原发灶切除后,前臂皮瓣同期修复重建。皮瓣外形设计为展翼式2个亚单位Kiss皮瓣,两亚单位长轴相交呈V字形,皮瓣切取后周边存留组织形成V-Y几何形态。Kiss皮瓣亚单位的长度和宽度根据受区面积大小做适当调整。皮瓣切取后将两个亚单位拼接,经血管吻合移植重建口腔肿瘤切除后的创面,供区按V-Y成形直接拉拢缝合关闭。结果:前臂Kiss皮瓣两个亚单位经拼接后的面积可以达到传统前臂皮瓣制备的面积;皮瓣供区均能一期关闭而无需植皮;2个亚单位均能获得独立血供而成活。结论:前臂2个亚单位Kiss皮瓣设计,V-Y成形直接关闭供区而无需植皮,避免了取皮创伤和植皮区的瘢痕形成,提高了美学效果,值得推广应用。

PURPOSE:The design and harvest of radial forearm(RF)flap was modified with kiss flap technique in order to achieve the aim that skin-graft in donor site was not necessarily performed.METHODS:The shape of RF flap was designed as two components of kiss flaps like flying wings.The long axis of the two components formed a V shape,and the surrounding retained tissues formed a V-Y geometry after the flap was harvested.The length and width of the components can be adjusted according to the size of the defects.Side-to-side stitching of the two components formed the final surface area to match recipient site and reconstruct the defect and the donor site was directly closed based on V-Y plasty.RESULTS:Reassembling of the two components of RF kiss flap reached the same area of traditional radial forearm flap and the components survived well based on the cutaneous perforator vessels.The donor-site was directly closed without skin-grafting.CONCLUSIONS:Kiss design of RF is an ideal technique as donor-site can be directly closed with less donor-site morbidities,less scar formation and no skin-grafting.