Herter F, Ninkovic M, Ninkovic M
Klinikum Muenchen-Bogenhausen, Munich, Germany.
J Plast Reconstr Aesthet Surg. 2007;60(7):760-8. doi: 10.1016/j.bjps.2007.03.008. Epub 2007 May 29.
Reconstruction of complex extremity trauma continues to be a challenging task for plastic surgeons. Characteristics of such injuries include destruction of functional structures, often due to high energy trauma that causes significant invalidity. Before the era of free flaps, pedicled fasciocutaneous and muscle flaps were the only option for reconstruction of the severely injured upper extremity. The management of complex injuries of the upper extremity has changed with the development of reconstructive microsurgery. Nowadays, we have a great variety of different free flaps to cover defects of the upper extremity and restore function by innervated free flaps. Sensibility, skin thickness, texture, colour, durability, binding of the flap to the underlying structures, donor site morbidity, possibility of secondary reconstructive procedures, the surgeon's experience and operative facilities must all be taken into consideration for choosing the optimal reconstructive procedure. Not only the reconstructive und functional requirements but the timing of reconstruction is extremely important for final result. The purpose of this paper is to define the principles of flap selection and timing of flap reconstruction, according to the assessment of trauma in the upper limb.
对于整形外科医生而言，复杂肢体创伤的重建仍是一项具有挑战性的任务。此类损伤的特点包括功能结构遭到破坏，这通常是由导致严重残疾的高能创伤所致。在游离皮瓣时代之前，带蒂筋膜皮瓣和肌皮瓣是严重受伤上肢重建的唯一选择。随着重建显微外科的发展，上肢复杂损伤的处理方式发生了变化。如今，我们有各种各样不同的游离皮瓣来覆盖上肢缺损，并通过带神经的游离皮瓣恢复功能。在选择最佳重建手术时，必须综合考虑感觉、皮肤厚度、质地、颜色、耐用性、皮瓣与深层结构的附着情况、供区并发症、二次重建手术的可能性、外科医生的经验以及手术设备等因素。不仅重建和功能需求，重建的时机对于最终结果也极为重要。本文的目的是根据上肢创伤的评估来确定皮瓣选择原则和皮瓣重建时机。
