Xie Yun, Lin Jianhua, Ye Junjian, Zheng Heping
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014 Nov;28(11):1368-71.
To investigate the effectiveness of using radial mid-forearm perforator fasciocutaneous flap to repair soft tissue defect in lower segment of the forearm and the wrist.
Between May 2007 and July 2012, 7 cases of soft tissue defect of lower segment of the forearm and the wrist were repaired with radial mid-forearm perforator fasciocutaneous flap. There were 6 males and 1 female with an average age of 38 years (range, 22-45 years). Defects were caused by crushing injury in 4 cases with the disease duration of 3-22 days (mean, 14 days), by internal fixation of ulnar comminuted fracture in 2 cases after 16 and 20 days of operation respectively, and by focal cleaning of wrist joint tuberculosis in 1 cases after 24 days of operation. The locations of defect were the lower segment of the forearm in 5 cases and the dorsal side of the wrist in 2 cases. The area of soft tissue defect ranged from 4 cm x 3 cm to 9 cm x 5 cm. The size of flap ranged from 6 cm x 4 cm to 12 cm x 6 cm. The donor site was closed with direct suturing or skin grafting.
The intraoperative blood loss was 50- 90 mL (mean, 64 mL); the operation time was 60-80 minutes (mean, 72 minutes). Six flaps survived with wound healing by first intention; partial flap necrosis occurred in 1 case, and delayed healing was obtained after dressing change. Skin grafting at donor sites survived with healing of incision bly first intention. The patients were followed up 3-14 months (mean, 9 months). No ulcer or sinus tract was observed; all flaps showed a slightly swollen appearance and had normal color.
Radial mid-forearm perforator fasciocutaneous flap does not need to dissect the source of blood vessels due to constantly anatomical structure. It has the advantages of easy operation, rich blood supply, high survival rate, and satisfactory clinical effect, so it is an important supplement of the other non-main vessel pedicle flaps to repair soft tissue defect in the lower segment of the forearm and the wrist.
探讨采用桡骨中1/3段前臂穿支筋膜皮瓣修复前臂下段及腕部软组织缺损的疗效。
2007年5月至2012年7月，采用桡骨中1/3段前臂穿支筋膜皮瓣修复7例前臂下段及腕部软组织缺损患者。其中男6例，女1例，平均年龄38岁（22～45岁）。4例因挤压伤致软组织缺损，病程3～22天（平均14天）；2例分别于尺骨粉碎性骨折内固定术后16天和20天出现软组织缺损；1例于腕关节结核病灶清除术后24天出现软组织缺损。缺损部位位于前臂下段5例，腕背部2例。软组织缺损面积为4 cm×3 cm～9 cm×5 cm。皮瓣面积为6 cm×4 cm～12 cm×6 cm。供区采用直接缝合或植皮闭合。
术中出血量50～90 ml（平均64 ml）；手术时间60～80分钟（平均72分钟）。6例皮瓣全部成活，伤口一期愈合；1例皮瓣部分坏死，经换药后延迟愈合。供区植皮全部成活，切口一期愈合。患者随访3～14个月（平均9个月）。未观察到溃疡或窦道形成；所有皮瓣外观稍肿胀，颜色正常。
桡骨中1/3段前臂穿支筋膜皮瓣因解剖结构恒定，无需解剖血管蒂。具有手术操作简便、血供丰富、成活率高、临床效果满意等优点，是修复前臂下段及腕部软组织缺损的其他非主干血管蒂皮瓣的重要补充。
