Mateev Musa A, Ogawa Rei, Trunov Leonid, Moldobaeva Nurgul, Hyakusoku Hiko
Bishkek, Kyrgyzstan; and Tokyo, Japan From the Department of Plastic, Reconstructive Microsurgery, and Hand Surgery and Department of Anesthesiology, National Hospital of Kyrgyzstan; and Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School.
Plast Reconstr Surg. 2009 May;123(5):1533-1543. doi: 10.1097/PRS.0b013e3181a07655.
To overcome the donor-site morbidity associated with radial forearm flaps, many modifications of this technique have been reported, including the development of the perforator flap method. In this article, the authors analyze the efficacy of their shape-modified radial artery perforator flap method.
The authors analyzed all of their 112 cases of reconstruction with the shape-modified method with regard to the cause of injury, recipient site, whether the flap was free or pedicled, flap size, number of components that were divided by perforators, flap survival, and quality of the outcome. Donor-site morbidity, including the development of scars and dorsal hand numbness, was also evaluated.
The reconstructed areas were the head and neck (27 cases, 24.1 percent), upper extremity (58 cases, 51.8 percent), and lower extremity (27 cases, 24.1 percent). Free flaps were used in 75 cases (67.0 percent). In total, 109 flaps (97.3 percent) survived completely, but three free flaps exhibited venous thrombosis. In terms of aesthetics, 48 cases had excellent outcomes (42.9 percent), 61 cases had good outcomes (54.5 percent), and three cases had poor outcomes (2.7 percent). Impaired blood circulation and numbness of the donor hand were never observed, but one patient complained about a donor-site cosmetic problem.
The authors' flap can be considered as a kind of propeller flap. It also resembles the flap-in-flap method. It is suitable for a wide range of surgical indications and is useful and safe in not only adults but also young and elderly patients.
为克服与桡侧前臂皮瓣相关的供区并发症，已报道了该技术的多种改良方法，包括穿支皮瓣法的发展。在本文中，作者分析了其形状改良的桡动脉穿支皮瓣法的疗效。
作者分析了采用形状改良法进行重建的112例患者的所有病例，内容包括损伤原因、受区、皮瓣是游离的还是带蒂的、皮瓣大小、被穿支分隔的组织成分数量、皮瓣存活情况及结果质量。还评估了供区并发症，包括瘢痕形成和手背麻木情况。
重建部位为头颈部（27例，24.1%）、上肢（58例，51.8%）和下肢（27例，24.1%）。75例（67.0%）采用游离皮瓣。总共109例皮瓣（97.3%）完全存活，但3例游离皮瓣出现静脉血栓形成。在美学方面，48例效果极佳（42.9%），61例效果良好（54.5%），3例效果差（2.7%）。未观察到供区手部血液循环受损和麻木情况，但1例患者抱怨供区存在美容问题。
作者的皮瓣可被视为一种推进皮瓣。它也类似于皮瓣套皮瓣法。它适用于广泛的手术适应证，不仅对成人，而且对年轻和老年患者均有用且安全。
