对偶三角瓣联合原位小面积全厚皮片修复前臂游离皮瓣供区缺损

Repair of donor site defect after forearm free flap harvest with dual triangular flaps and in situ small full thickness skin flaps

目的:介绍一种对偶三角瓣联合原位小面积全厚皮片修复前臂游离皮瓣供区缺损的方法。方法:对25例口腔鳞癌患者行前臂游离皮瓣修复肿瘤切除术后缺损,在制备前臂游离皮瓣的同时,进行供区对偶三角瓣及邻近小面积全厚皮片的设计和制取,原位修复供区缺损。结果:25例前臂供区缺损均成功采用供区对偶三角瓣联合原位小面积全厚皮片修复。用于关闭前臂供区缺损的邻近全厚皮片均存活,创口愈合良好,无迟发性创面破裂,未发生供区严重并发症。取瓣侧手臂肘腕关节运动正常,掌部血运正常,前臂皮瓣供区缺损修复区域与周围组织皮肤色泽接近,无凹陷畸形,无挛缩畸形。与腹部取皮组相比,前臂邻近皮片修复组在术后肿胀和腕关节运动没有明显差异的情况下,瘢痕感染几率减少,肌腱外露风险降低,大大提高了前臂术区的美观性。结论:改良供区对偶三角瓣联合邻近全厚皮片修复技术减少了术中和术后恢复时间,避免第三术区的创伤,值得在临床上应用。

PURPOSE:To introduce a method of repairing donor site defect after forearm free flap harvest with dual triangular flaps combined with in situ small full thickness skin flaps.METHODS:Free forearm skin flaps were applied for repairing defects after tumor resection in 25 patients with oral squamous cell carcinoma.In order to repair the donor site defect in situ,the dual triangular flaps and adjacent full-thickness skin flaps were designed and fabricated while the forearm free flaps were prepared.RESULTS:Twenty-five cases with forearm donor site defects were successfully repaired with dual triangular flaps combined with in situ small full thickness skin grafts.All the adjacent full-thickness skin grafts used to close the donor site defect of forearm survived,and the wound healed well without delayed wound rupture and serious complications.The movement of elbow and wrist joint on the side of the flap was normal,blood supply in the palm was normal,and the skin color of the donor site of the forearm skin flap was similar to the surrounding tissue.There was no deficiency or contracture deformity.Moreover,compared with the abdominal skin grafting group,there was no significant difference in swelling and wrist movement between the forearm adjacent skin grafting group and the abdominal skin grafting group,but the former technique reduced the risk of scar infection and tendon exposure,and greatly improved the aesthetics of the donor site.CONCLUSIONS:Modified donor dual triangular flaps combined with adjacent full thickness skin graft can reduce the recovery time during and after operation and avoid the trauma in the third operation area.It is worthy of practical application in the preparation of forearm skin flaps in oral and maxillofacial surgery.