Hsieh Ching-Hua, Kuo Yur-Ren, Yao Sheng-Fa, Liang Chi-Cheng, Jeng Seng-Feng
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital in Kaohsiung, Chang Gung University, Kaohsiung Hsien, Taiwan.
Plast Reconstr Surg. 2004 Apr 15;113(5):1355-60. doi: 10.1097/01.prs.0000112742.51430.a7.
To primarily repair a series of radial forearm flap donor defects, a total of 10 bilobed flaps based on the fasciocutaneous perforator of the ulnar artery were designed at the Chang Gung Memorial Hospital in Kaohsiung in the period from January of 2002 to January of 2003. All patients were male, with ages ranging from 36 to 67 years. The forearm donor defects ranged in size from 5 x 6 cm to 8 x 8 cm, with the average defect being 47 cm. One to three sizable perforators from the ulnar artery were consistently observed in the distal forearm and were most frequently located 8 cm proximal to the pisiform, which could be used as a pivot point for the bilobed flap. The bilobed flap consisted of two lobes, one large lobe and one small lobe. With elevation and rotation of the bilobed flap, the large lobe of the flap was used to repair the radial forearm donor defect and the small lobe was used to close the resultant defect from the large lobe. All bilobed flaps survived completely, without major complications, and no skin grafting was necessary. Compared with conventional methods for reconstruction of radial forearm donor defects, such as split-thickness skin grafting, the major advantage of this technique is its ability to reconstruct the donor defect with adjacent tissue in a one-stage operation. Forearm donor-site morbidity can be minimized with earlier hand motion, and better cosmetic results can be obtained. Furthermore, because a skin graft is not used, no additional donor area is necessary. However, this flap is suitable for closure of only small or medium-size donor defects. A lengthy postoperative scar is its major disadvantage.
为了一期修复一系列前臂桡侧皮瓣供区缺损，2002年1月至2003年1月期间，高雄长庚纪念医院设计了10个以尺动脉筋膜皮穿支为基础的双叶皮瓣。所有患者均为男性，年龄在36至67岁之间。前臂供区缺损大小从5×6 cm至8×8 cm不等，平均缺损面积为47 cm²。在前臂远端始终能观察到1至3支较粗大的尺动脉穿支，最常见于豌豆骨近端8 cm处，可作为双叶皮瓣的旋转点。双叶皮瓣由两个叶组成，一个大叶和一个小叶。随着双叶皮瓣的掀起和旋转，皮瓣的大叶用于修复前臂桡侧供区缺损，小叶用于闭合大叶掀起后产生的缺损。所有双叶皮瓣均完全存活，无严重并发症，无需植皮。与传统的前臂桡侧供区缺损修复方法如刃厚皮片移植相比，该技术的主要优点是能够在一期手术中用相邻组织修复供区缺损。早期手部活动可将前臂供区的发病率降至最低，并可获得更好的美容效果。此外，由于未使用皮片，无需额外的供皮区。然而，该皮瓣仅适用于闭合中小尺寸的供区缺损。术后瘢痕较长是其主要缺点。
