游离上臂外侧皮瓣在手部皮肤软组织缺损中的应用

Application of lateral upper arm free flap in the treatment of skin and soft tissue defects of hand

目的探讨采用游离上臂外侧皮瓣移植修复中、小面积手部皮肤软组织缺损的临床疗效。方法自2015年1月至2020年1月,北部战区总医院烧伤整形科收治15例手部皮肤软组织缺损患者,采用上臂外侧皮瓣游离移植修复。软组织缺损面积1.5 cm×5.0 cm~5.0 cm×7.0 cm。术后随访6~12个月,密切观察皮瓣的成活率、色泽、温度、毛细血管充盈反应和皮瓣的感觉恢复情况。统计受区并发症情况,评定手感觉功能。结果1例术后发生静脉危象,经及时探查重新吻合血管后愈合。13例皮瓣成活,2例皮瓣远端发生部分坏死,经换药后愈合。3例皮瓣略臃肿,术后6个月二期行皮瓣修整术,其余患者皮瓣质地及外观良好。手部功能满意度,14例优,1例良。手部感觉均为优良,受区无明显严重并发症发生。结论游离上臂外侧皮瓣移植修复中、小面积手部皮肤软组织缺损临床效果满意,是修复中、小面积手部皮肤软组织缺损的理想皮瓣。

Objective To explore the clinical efficacy of lateral upper arm free flap transplantation in the repair of small and medium-sized skin and soft tissue defects of hand.Methods From January 2015 to January 2020,15 patients with skin and soft tissue defects of hand were repaired by lateral upper arm free flap transplantation.The area of defects ranged from 1.5 cm×5.0 cm to 5.0 cm×7.0 cm.All patients were followed up for 6 to 12 months.The survival rate,color,temperature,capillary filling reaction and sensory recovery of flap were observed.The complications of recipient site were counted and the sensory function of hand was evaluated.Results One patient developed venous crisis after operation,which healed after timely exploration and reanastomosis.Thirteen flaps survived,2 flaps had partial necrosis and healed after dressing change.Three cases of flaps were slightly bloated and two-stage flap repair was performed at6 months after operation.The remaining patients had good texture and appearance of flap.The recovery of hand function was satisfactory,14 cases were excellent and 1 case was good.The sensory recovery of hand was good.No serious complications occurred in the recipient area.Conclusion The lateralupper arm free flap is an idealflap in the repair ofsmalland medium-sized skin and softtissue defects ofhand.