Wysocki Robert W, Gray Robert L, Fernandez John J, Cohen Mark S
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Hand Surg Am. 2008 Dec;33(10):1807-12. doi: 10.1016/j.jhsa.2008.08.019.
The purpose of this study is to evaluate the coverage patterns of whole and split flexor carpi ulnaris (FCU) pedicle muscle flaps for posterior elbow soft-tissue defects.
Seventeen fresh-frozen cadaveric upper extremities were used. The whole FCU was raised to the dominant vascular pedicle and transposed proximally over the olecranon. The widths of coverage at 2-cm distances about the posterior elbow were measured. Widths were also measured after making 3 longitudinal cuts in the fascia and after suturing the muscle to adjacent soft tissue under tension. The FCU was also split into its ulnar and humeral heads along the central tendon. The larger ulnar head was transposed and the widths again measured. Mid-forearm circumference, elbow circumference, and ulnar length were assessed for ability to predict flap width.
The whole muscle under no tension provided an average of 2.7 cm width coverage at the tip of the olecranon process. Cutting the fascia provided approximately 15% additional width and suturing the muscle to the surrounding soft tissue an additional 25%, to approximately 4 cm. The isolated FCU ulnar head provided approximately 75% of the width of the entire muscle. Mid-forearm circumference was the most predictive of flap width, and divisors were generated that improved the accuracy of predicting the width for outlier specimens. The dominant pedicle was a consistent distance relative to the end of the central tendon and the olecranon tip.
The whole and split FCU pedicle flaps provide predictable coverage for 2- to 4-cm posterior elbow soft-tissue defects. For especially large and small arms, the divisors improve accuracy in predicting flap width. Consistent locations of the olecranon tip and the end of the central tendon in relation to the dominant pedicle make them useful surgical landmarks.
本研究旨在评估全层及劈开的尺侧腕屈肌（FCU）蒂肌皮瓣修复肘部后方软组织缺损的覆盖模式。
使用17具新鲜冷冻的尸体上肢。将完整的FCU向优势血管蒂掀起并向近端移位至尺骨鹰嘴上方。测量肘部后方2厘米间距处的覆盖宽度。在筋膜上做3条纵向切口后以及在张力下将肌肉缝合至相邻软组织后也测量宽度。还将FCU沿中央腱劈分为尺骨头和肱骨头。将较大的尺骨头移位并再次测量宽度。评估前臂中部周长、肘部周长和尺骨长度预测皮瓣宽度的能力。
无张力下的整块肌肉在尺骨鹰嘴尖处平均提供2.7厘米的宽度覆盖。切开筋膜可额外提供约15%的宽度，将肌肉缝合至周围软组织可再增加25%，达到约4厘米。分离的FCU尺骨头提供了整块肌肉宽度的约75%。前臂中部周长对皮瓣宽度的预测性最强，并生成了除数以提高异常标本宽度预测的准确性。优势血管蒂相对于中央腱末端和尺骨鹰嘴尖的距离一致。
全层及劈开的FCU蒂皮瓣可为2至4厘米的肘部后方软组织缺损提供可预测的覆盖。对于特别大和特别小的手臂，除数可提高皮瓣宽度预测的准确性。尺骨鹰嘴尖和中央腱末端相对于优势血管蒂的位置一致，使其成为有用的手术标志。
