Plastic and Reconstructive Surgery Unit, Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia; AORTEC Unit, Faculty of Health Science, Australian Catholic University, O'Brien Institute, Fitzroy, Victoria 3065, Australia.
J Plast Reconstr Aesthet Surg. 2013 Nov;66(11):1613-5. doi: 10.1016/j.bjps.2013.02.011. Epub 2013 Mar 7.
Full-thickness soft-tissue defects overlying vital forearm or wrist structures frequently result from acute trauma or tumor ablation. These defects present reconstructive challenges, due to the thin pliable skin to be replaced and the non-graftable bed beneath. The authors discuss a case of a renal-transplant patient with a volar wrist SCC, in whom local vascular anatomy deemed microvascular free tissue transfer inappropriate. The authors present a successful novel reconstructive solution; the pedicled inferior paraumbilical perforator flap (I-PUP), a two-staged procedure that incorporates principles of distant flaps--which pre-date microsurgery--combined with techniques and lessons learned in the era of perforator flap surgery.
覆盖重要前臂或手腕结构的全层软组织缺损通常由急性创伤或肿瘤消融引起。这些缺陷带来了重建挑战，因为需要替换的是薄而柔韧的皮肤，而下面的组织又不能移植。作者讨论了一名肾移植患者患有掌侧手腕 SCC 的病例，局部血管解剖认为微血管游离组织转移不合适。作者提出了一种成功的新颖重建解决方案；带蒂下脐旁穿支皮瓣（I-PUP），这是一种两阶段手术，结合了远皮瓣的原则——远皮瓣先于显微外科出现——结合了穿支皮瓣手术时代的技术和经验。
