Yajima H, Tamai S, Yamauchi T, Mizumoto S
Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan.
J Hand Surg Am. 1999 May;24(3):594-603. doi: 10.1053/jhsu.1999.0594.
We treated 5 patients (4 men and 1 woman) with bone and soft tissue defects or total thumb loss using an osteocutaneous radial forearm flap. Their ages at the time of surgery ranged from 27 to 65 years (mean, 53 years). Preoperative conditions were traumatic loss of the thumb in 3 cases and severe injuries with soft tissue and bone defects in 2. The length of the donated radius ranged from 2 to 7 cm (mean, 4.7 cm). In 4 patients the radial forearm flap was transposed, including the lateral antebrachial cutaneous nerve as a sensory flap. Simultaneous iliac bone grafting to the donor site was also performed in 4 of the cases. The follow-up period ranged from 44 to 87 months (mean, 64 months). All flaps survived over their full extent. Radiographic bone union was attained after 2 to 3 months (mean, 2.5 months). Two-point discrimination over the 4 sensory flaps ranged from 8 to 15 mm (mean, 10.8 mm). No radius fractures occurred. No patients showed signs of vascular insufficiency from sacrifice of the radial artery. The radial forearm flap provides thin skin of good texture together with bone for a 1-stage reconstruction. For patients with skin and bone defects of the hand, a radial forearm osteocutaneous flap is recommended. This flap is also recommended for patients with traumatic thumb loss, if the dorsalis pedis artery is absent, or if the patient declines using tissue from the foot.
我们使用桡骨前臂骨皮瓣治疗了5例（4例男性和1例女性）存在骨与软组织缺损或拇指完全缺失的患者。手术时他们的年龄在27至65岁之间（平均53岁）。术前情况为3例拇指创伤性缺失，2例伴有软组织和骨缺损的严重损伤。所取桡骨长度在2至7厘米之间（平均4.7厘米）。4例患者转移了桡骨前臂皮瓣，包括前臂外侧皮神经作为感觉皮瓣。4例患者同时还对供区进行了髂骨移植。随访期为44至87个月（平均64个月）。所有皮瓣均完全存活。术后2至3个月（平均2.5个月）实现了影像学骨愈合。4个感觉皮瓣的两点辨别觉在8至15毫米之间（平均10.8毫米）。未发生桡骨骨折。没有患者因桡动脉牺牲而出现血管供血不足的迹象。桡骨前臂皮瓣可提供质地良好的薄皮肤以及骨组织用于一期重建。对于手部存在皮肤和骨缺损的患者，推荐使用桡骨前臂骨皮瓣。对于创伤性拇指缺失的患者，如果足背动脉缺如，或患者拒绝使用足部组织，也推荐使用该皮瓣。
