改良嵌合型桡侧副动脉穿支皮瓣修复手部复合组织缺损
Modified chimeric radial collateral artery perforator flap for repairing hand composite defects.
作者信息
Liu Jun, Song Dajiang, Wu Song, Li Jinsong, Deng Xiangwu, Li Kuangwen, Lv Hongbin, Xu Jian
机构信息
Department of Sports Medicine, Xiangya Hospital of Central South University, Changsha, China.
Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
出版信息
J Reconstr Microsurg. 2015 Mar;31(3):171-8. doi: 10.1055/s-0034-1390324. Epub 2014 Oct 31.
BACKGROUND
The authors presented their clinical experience and demonstrated surgical methods for reconstructing complex bone and soft tissue defects of the hand by using modified chimeric radial collateral artery perforator flaps.
METHODS
Surgical procedures that employed 16 modified chimeric radial collateral artery perforator flaps and 3 dual paddle flaps were performed in 16 patients. Among the patients, eight had defects in the metacarpal bones and eight had defects in the phalanx bones. The flaps were created with a skin paddle and humeral bone segments by using independent perforators. The flaps ranged in size from 5.5 × 2.0 to 7.5 × 4.5 cm, whereas the humeral fragments ranged in size from 1.5 × 0.5 to 4.0 × 1.5 cm. The pedicle of the flaps was divided and ligated below the level at which the radial collateral artery separates into anterior and posterior branches. The recipient vessels were the proper digital artery, the palmar subcutaneous vein (n = 12), the deep branch of the palmar ulnar artery (n = 4), and the venae comitantes. The cosmetic appearance of both donor and recipient sites was evaluated during a follow-up visit.
RESULTS
Postoperative venous congestion occurred in two cases. The venous obstruction was reanastomosed after venous thrombectomy. The procedures were successful in both cases upon examination. All the flaps survived and all the donor sites were closed directly, leaving only a linear scar. Follow-up time ranged from 12 to 28 months. Bone components achieved union in all cases at an average of 5.4 months (ranging from 3 to 6 months). In two cases, the flap was defatted during the late postoperative period. Cosmetically acceptable results were achieved for the rest of the patients.
CONCLUSION
The modified chimeric radial collateral artery perforator flap is a good alternative for reconstructing complex bone and soft tissue defects of the hands.
LEVEL OF EVIDENCE
This is a level IV, retrospective series.
背景
作者介绍了他们的临床经验，并展示了使用改良嵌合桡侧副动脉穿支皮瓣修复手部复杂骨与软组织缺损的手术方法。
方法
对16例患者实施了采用16个改良嵌合桡侧副动脉穿支皮瓣和3个双叶皮瓣的手术。患者中，8例掌骨有缺损，8例指骨有缺损。皮瓣通过独立穿支形成一个皮瓣叶和肱骨骨段。皮瓣大小为5.5×2.0至7.5×4.5厘米，而肱骨骨块大小为1.5×0.5至4.0×1.5厘米。皮瓣蒂在桡侧副动脉分为前后分支的水平以下进行切断和结扎。受区血管为指固有动脉、掌皮下静脉（n = 12）、掌尺侧动脉深支（n = 4）和伴行静脉。在随访期间评估供区和受区的外观。
结果
2例出现术后静脉淤血。静脉血栓切除术后对静脉阻塞进行了重新吻合。经检查，两例手术均成功。所有皮瓣均存活，所有供区均直接闭合，仅留下一条线性瘢痕。随访时间为12至28个月。所有病例中骨成分平均在5.4个月（3至6个月）实现愈合。2例在术后晚期皮瓣出现脂肪液化。其余患者获得了外观上可接受的结果。
结论
改良嵌合桡侧副动脉穿支皮瓣是修复手部复杂骨与软组织缺损的良好选择。
证据水平
这是一个IV级回顾性系列研究。
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