Tang Xiujun, Wei Zairong, Wang Bo, Zeng Xueqin, Tan Jing
Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou 563003, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Aug;26(8):943-5.
To explore the effectiveness of the improved pedicled superficial iliac circumflex artery flap for repairing serious wound of the hand and forearm.
Between June 2008 and June 2011, 13 cases of serious wound of the hand and forearm were treated. There were 9 males and 4 females with a mean age of 41 years (range, 23-64 years). The disease causes included twist injury by machine in 2 cases, wire rope squeezed injury in 4 cases, traffic accident injury in 3 cases, crushing injury in 2 cases, high voltage electrical injury in 1 case, and snake bites in 1 case. There were 10 cases of fresh wounds and 3 cases of infection and necrosis wounds, and all had bone and tendon exposure. The skin and soft tissue defects ranged from 7 cm x 3 cm to 22 cm x 6 cm. The pedicled iliac artery flap was used in 8 cases, and pedicled iliac artery composite flap in 5 cases. The flap size ranged from 12 cm x 4 cm to 27 cm x 8 cm, with the flap pedicle of 2-4 cm wide strip and 3-5 cm wide fascia.
The pedicle of flap was cut at 3 weeks in 12 patients, and at 4 weeks in 1 patient who had partial avulsion and hemorrhage at 1 week after operation. All flaps survived and incisions at donors and wounds healed by first intention. Eleven patients were followed up 6-36 months (mean, 20 months). The flap color and texture were good; 3 bulky flaps were observed, and satisfactory appearance was achieved after skin flap thinning. After 6 months, the protective sensation recovered in all cases; according to the Hand Surgery Society of Chinese Medical Association evaluation of upper extremity function trial standard for total active motion of the fingers, the results were excellent in 9 cases, good in 1 case, and poor in 1 case.
Improved fascia pedicled superficial iliac circumflex artery skin flap can repair serious hand and forearm injury, which is easy-to-operate and less injury at donor site.
探讨改良带蒂旋髂浅动脉皮瓣修复手部及前臂严重创面的疗效。
2008年6月至2011年6月，治疗手部及前臂严重创面13例。其中男9例，女4例，平均年龄41岁（23 - 64岁）。致伤原因包括机器绞伤2例，钢丝绳挤压伤4例，交通事故伤3例，碾压伤2例，高压电伤1例，蛇咬伤1例。新鲜创面10例，感染坏死创面3例，均有骨及肌腱外露。皮肤软组织缺损范围为7 cm×3 cm至22 cm×6 cm。采用带蒂髂动脉皮瓣8例，带蒂髂动脉复合皮瓣5例。皮瓣大小为12 cm×4 cm至27 cm×8 cm，皮瓣蒂部为宽2 - 4 cm的条带及宽3 - 5 cm的筋膜。
12例患者于术后3周断蒂，1例术后1周出现部分撕脱出血，于术后4周断蒂。所有皮瓣均成活，供区及受区切口均一期愈合。11例患者随访6 - 36个月（平均20个月）。皮瓣颜色、质地良好；出现3例臃肿皮瓣，经皮瓣修薄后外观满意。6个月后，所有病例保护性感觉均恢复；按照中华医学会手外科学分会上肢功能试验总主动活动度评定标准，优9例，良1例，差1例。
改良带蒂旋髂浅动脉筋膜皮瓣可修复手部及前臂严重损伤，手术操作简便，供区损伤小。
