Cai Peihua, Liu Shenghe, Wang Haiming, Ruan Hongjiang, Chai Yimin
Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, 200233, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008 Jun;22(6):724-7.
To investigate the operative techniques and clinical results of repairing the soft tissue defects of forearm and hand with free peroneal perforator-based sural neurofasciocutaneous flap.
From May 2006 to January 2007, 6 patients including 5 males and 1 female were treated. Their ages ranged from 22 years to 51 years. They were injured by motor vehicle accidents (2 cases), or crushed by machines (4 cases), with skin defect of hand in 1 case, skin defect of hand associated with tendon injuries and metacarpal fractures in 2 cases, skin defect of forearm in 2 cases, and forearm skin defects with fractures of radius and ulna in 1 case. The areas of soft tissue defect ranged from 16 cm x 7 cm to 24 cm x 10 cm. The debridement and the primary treatment to tendons or bones were performed on emergency. And free flaps were transplanted when the wound areas were stable at 4 to 7 days after the emergent treatment. During the operation, the flaps were designed along the axis of the sural nerve nutrient vessels according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascular anastomosis. Then the flaps were harvested and transferred to the recipient sites with the peroneal varley anastomosed to the radial (or ulnar) artery and the peroneal veins to one of the radial (or ulnar) veins and the cephalic vein, respectively. The flap size ranged from 18 cm x 8 cm to 25 cm x 12 cm. The donor areas were closed by skin grafts.
The 5 flaps survived after the surgery. Partial inadequate venous return and distal superficial necrosis happened in only 1 case, which also got secondary healing by changing dressing and anti-infective therapy. The donor sites reached primary healing completely. The followed-up in all the patients for 6 to 13 months revealed that the appearance and function of the flaps were all satisfactory, and no influence on ambulation of donor site was found.
Peroneal perforator-based sural neurofasciocutaneous flap has the advantages of favourable appearance, constant vascular pedicle, reliable blood supply, large size of elevation and minor influence on the donor site. And the free transfer of this flap is an ideal procedure to repair the large soft tissue defects of forearm and hand.
探讨以腓动脉穿支为蒂的腓肠神经营养血管皮瓣修复前臂及手部软组织缺损的手术方法及临床效果。
2006年5月至2007年1月，共治疗6例患者，其中男5例，女1例。年龄22岁至51岁。致伤原因：机动车事故伤2例，机器碾压伤4例。手部皮肤缺损1例，手部皮肤缺损伴肌腱损伤及掌骨骨折2例，前臂皮肤缺损2例，前臂皮肤缺损伴尺桡骨骨折1例。软组织缺损面积为16 cm×7 cm至24 cm×10 cm。急诊行清创及肌腱或骨骼的一期处理。急诊处理后4至7天，待创面情况稳定后行游离皮瓣移植。术中根据软组织缺损的形状和大小，沿腓肠神经营养血管轴线设计皮瓣，以外踝上腓动脉穿支为蒂，携带部分腓动脉进行血管吻合。然后切取皮瓣，将腓动脉与桡（或尺）动脉吻合，腓静脉分别与桡（或尺）静脉及头静脉之一吻合，转移至受区。皮瓣大小为18 cm×8 cm至25 cm×12 cm。供区采用植皮覆盖。
术后5例皮瓣全部成活。仅1例出现部分静脉回流不畅及皮瓣远端浅层坏死，经换药及抗感染治疗后二期愈合。供区均一期完全愈合。所有患者随访6至13个月，皮瓣外观及功能均满意，供区行走功能未受影响。
以腓动脉穿支为蒂的腓肠神经营养血管皮瓣具有外观良好、血管蒂恒定、血供可靠、切取面积大、对供区影响小等优点。该皮瓣游离移植是修复前臂及手部较大软组织缺损的理想方法。
