Moffett T R, Madison S A, Derr J W, Acland R D
Department of Surgery, University of Louisville, Ky.
Plast Reconstr Surg. 1992 Feb;89(2):259-67. doi: 10.1097/00006534-199202000-00010.
We present an extension of the surgical approach for harvesting the lateral upper arm free flap by which an additional 6 to 8 cm of pedicle length may be gained. First, the flap is raised by the standard lateral approach. Then, by proceeding proximally and posteriorly, the triceps muscle is split between its lateral and long heads to expose the entire length of the profunda brachii vessels in the spiral groove. A tunnel is developed beneath the lateral head of the triceps, and the flap or its pedicle is delivered through this. We describe the surgical technique and present details of a dissection study on 25 fresh cadaver limbs. The nerve branches to the lateral head of the triceps, which are close to the vessels of the flap, are highly variable in number and location. When unusually short and distally placed, they are at risk of damage, but damage can be avoided if the tunnel is not unduly widened. We present our early clinical experience in 10 consecutive cases using the extended-pedicle lateral arm flap. The free pedicle length in this series ranged from 8 to 13 cm. The maximum flap size was 5 x 19 cm. All cases were successful, although one required reoperation for venous thrombosis. Although postoperative testing of upper arm muscle function showed some weakness and impaired endurance, this was found equally in the surgically disturbed triceps and in the untouched elbow flexors and thus could not be attributed to motor nerve damage to the triceps muscle.
我们提出了一种用于切取上臂外侧游离皮瓣手术方法的扩展术式，通过该方法可使蒂部长度额外增加6至8厘米。首先，采用标准的外侧入路掀起皮瓣。然后，向近端和后方操作，在肱三头肌外侧头和长头之间劈开，以暴露螺旋沟内肱深血管的全长。在肱三头肌外侧头下方构建一条隧道，将皮瓣或其蒂部通过此隧道引出。我们描述了该手术技术，并展示了对25条新鲜尸体上肢进行解剖研究的细节。肱三头肌外侧头的神经分支靠近皮瓣血管，其数量和位置变化很大。当它们异常短小且位置靠下时，有受损风险，但如果隧道不过度加宽，可避免损伤。我们介绍了连续10例使用延长蒂上臂外侧皮瓣的早期临床经验。该系列中游离蒂的长度为8至13厘米。最大皮瓣尺寸为5×19厘米。所有病例均获成功，尽管有1例因静脉血栓形成需要再次手术。尽管术后对上臂肌肉功能的测试显示有一些无力和耐力受损，但在手术中受到干扰的肱三头肌以及未触及的肘屈肌中均有发现，因此不能归因于肱三头肌的运动神经损伤。
