张力对改良前臂皮瓣供区恢复的影响

Effect of tension on recovery of the donor site of a modified forearm flap

目的探讨张力对改良前臂皮瓣(使用前臂供区皮片关闭前臂术创)供区恢复的影响。方法对2018年10月至2021年4月于徐州市中心医院就诊的12名经前臂皮瓣修复的口腔癌患者,术前记录患者双手握力及腕关节活动度,前臂供区关创,使用前臂供区的三角形全厚皮片关闭部分术创,另一部分术创直接拉拢缝合,供区关创时用拉力计测量张力。术后对患者进行随访,观察患者术后供区创口有无坏死、愈合不良等并发症及供区侧前臂握力及腕关节活动度、外形满意度。结果 12例患者中仅1例高龄患者术后供区皮片近腕侧坏死情况,该患者平均张力为0.65 kg,经换药后二期愈合;其余患者术后供区未出现并发症。12例患者平均张力大小为(0.51±0.05)kg。12例患者术前术后握力分别为(23.7±10.3)kg、(22.3±10.7)kg,差异无统计学意义(t=5.872,P<0.001);术前术后腕关节活动度分别为掌屈(47.6±8.3)°、(45.8±5.8)°;背伸(54.6±3.2)°、(53.9±2.3)°;桡偏(37.0±2.3)°、(36.1±2.2)°;尺偏(27.1±1.9)°、(26.4±1.3)°。四个方向的活动度术前术后差异均无统计学意义,t值依次为1.64、1.636、2.116、1.412,P值依次为0.129、0.13、0.058、0.186。12例患者对术后前臂供区外形均较满意。结论改良前臂皮瓣供区缝合时平均张力在0.5 kg以下时,前臂供区术后并发症较少,对患者供区功能的影响小,患者对供区外观满意度较高。

Objective To investigate the effect of tension on donor site recovery of modified forearm flaps(closed forearm donor site skin flaps). Methods From October 2018 to April 2021, 12 patients with oral cancer underwent forearm flap repair at Xuzhou Central Hospital. Handgrip strength and wrist motion were recorded before surgery. During the surgical incision at the donor site of the forearm, the triangular full-thickness skin of the donor site was used to close part of the surgical incision, and the other part of the surgical incision was directly closed and sutured. Tension was measured with a tension meter during the surgical incision at the donor site. Patients were followed up after surgery to observe whether there were postoperative complications such as necrosis and poor healing of donor site wounds, as well as forearm grip strength, wrist range of motion and appearance satisfaction. Results Among the 12 patients, there was only one elderly patient with postoperative necrosis near the wrist in the donor site skin, and the average tension of the patient was 0.65 kg;the lesion healed after dressing changes. All of the other patients recovered well without postoperative complications. The mean tension of 12 patients was(0.51 ± 0.05) kg. The preoperative and postoperative grip strength of 12 patients was(23.7 ± 10.3) kg and(22.3 ± 10.7) kg, respectively, and the difference was not statistically significant(t=5.872, P<0.001). The mean range of motion of the wrist was(47.6 ± 8.3)°,(45.8 ± 5.8)°;dorsiflexion(54.6 ± 3.2)°,(53.9 ± 2.3)°;radial deviation(37.0 ± 2.3)°,(36.1 ± 2.2)°;ruler deviation(27.1 ± 1.9)°,(26.4 ± 1.3)°, respectively. The t values were 1.64, 1.636, 2.116 and 1.412, and the P values were 0.129, 0.130, 0.058 and 0.186, respectively. All 12 patients were satisfied with the appearance of the donor site of the forearm. Conclusion When the average tension during suturing is less than 0.5 kg, there is a lower risk of complications at the donor site of the forearm one month after surgery, a lower risk of impaired donor site function, and a greater possibility of patient satisfaction with the appearance of the donor site.