逆行前臂桡动脉穿支筋膜蒂皮瓣修复腕部软组织缺损

Reverse forearm radial artery perforator fasciocutaneous flap for repairing soft tissue defect of wrist

目的探讨逆行前臂桡动脉穿支筋膜蒂皮瓣修复腕部软组织缺损的临床疗效。方法应用逆行前臂桡动脉穿支筋膜蒂皮瓣修复16例腕部软组织缺损患者。缺损面积6.0 cm×4.0 cm^11.0 cm×6.0 cm,皮瓣设计面积6.5 cm×5.0 cm^12.0 cm×7.0 cm。结果13例皮瓣成活,无血管危象发生;1例外伤性缺损及2例感染性缺损患者皮瓣远端少量坏死,给予换药后伤口愈合。患者均获得随访,时间6~20个月。末次随访时,皮瓣外形良好,质地、色泽接近受区;根据中华医学会手外科学分会上肢部分功能评定标准评定腕关节功能:优8例,良6例,可2例,优良率14/16。结论逆行前臂桡动脉穿支筋膜蒂皮瓣具有切取方便、供区损伤小、疗效可靠、风险小等优点,虽然部分皮瓣术后出现边缘少量坏死,但仍是修复腕部软组织缺损较理想的手术方式之一。

Objective To investigate the clinical efficacy of reverse forearm radial artery perforator fasciocutaneous flap for repairing soft tissue defect of wrist.Methods A total of 16 patients with soft tissue defects of the wrist were collected.The area of soft tissue defect was 6.0 cm×4.0 cm^11.0 cm×6.0 cm,designed flap area was 6.5 cm×5.0 cm^12.0 cm×7.0 cm.Results Flaps of 13 patients survived,and no vascular crisis occurred.A small amount of necrosis occurred at the distal end of flaps in 1 patient with traumatic defect and 2 patients with infectious defect,they achieved secondary healing after dress changing.All patients were followed up from 6 months to 20 months.At the last follow-up,the appearance of flaps were good,slight bloated,the texture and color of the flaps were close to the recipient site.According to the functional assessment criteria for upper extremities issued by the Hand Society of the Chinese Medical Association,the results were excellent in 8 cases,good 6 cases,and fair in 2,the excellent and good rate was 14/16.Conclusions Reverse forearm radial artery perforator fasciocutaneous has the advantages of easy cut,less damage of supply area,reliable efficacy and low risk.Although a small amount of flap marginal necrosis occurre in some flaps after operation,reverse forearm radial artery perforator fasciocutaneous flap is still one of the ideal methods to repair the soft tissue defect of wrist.