Xiao Sen, Liu Guangjun, Tan Qi, Wang Qian, Wang Chengqi
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Feb;29(2):194-7.
To introduce the surgical method and effectiveness of repairing skin and soft tissue defect in the palm or dorsum of the hand and forearm with epigastric bilobed flap.
Between October 2010 and December 2013, 4 male patients with skin and soft tissue defect in the palm or dorsum of the hand and forearm were treated, aged from 36 to 62 years. Of them, 3 cases had degloving injury caused by machines and 1 case had necrosis of fingers and skin after surgery of crush injury. The time from injury to hospitalization was from 3 hours to 15 days. Among the 4 cases, the size of palmar defect was 7 cmx4 cm to 16 cmx6 cm, and the size of dorsal defect was 10 cmx7 cm to 20 cmx10 cm. The epigastric bilobed flap was designed based on the axial vessel which was formed by inferior epigastric artery, superior epigastric artery, and intercostals arteries. The size of flap ranged from 12 cmx4 cm to 18 cmx6 cm in the vertical direction, 15 cmx8 cm to 22 cmx11 cm in the oblique direction. The donor site was directly closed. The pedicles were cut at 22 to 24 days after repairing operation.
All the flaps survived well with the wound healing by first intention. Four patients were followed up 3 months to 1 year and 2 months. The other flaps had good appearance and texture except 1 bulky flap. The flap sensation basically restored to S2-S3. The function of the hands recovered well.
Skin and soft tissue defect in the palm or dorsum of the hand and forearm can be repaired with the epigastric bilobed flap, because it has such advantages as big dermatomic area and adequate blood supply. Besides, the operation is practical, safe, and simple.
介绍应用腹壁双叶皮瓣修复手掌、手背及前臂皮肤软组织缺损的手术方法及效果。
2010年10月至2013年12月，收治4例手掌、手背及前臂皮肤软组织缺损患者，年龄36～62岁。其中3例为机器绞轧伤致脱套伤，1例为挤压伤术后手指及皮肤坏死。受伤至入院时间为3小时至15天。4例中，手掌缺损面积为7 cm×4 cm至16 cm×6 cm，手背缺损面积为10 cm×7 cm至20 cm×10 cm。以腹壁下动脉、腹壁上动脉及肋间动脉形成的轴型血管为基础设计腹壁双叶皮瓣。皮瓣垂直方向大小为12 cm×4 cm至18 cm×6 cm，斜向大小为15 cm×8 cm至22 cm×11 cm。供区直接缝合。修复术后22～24天断蒂。
所有皮瓣均成活良好，创面一期愈合。4例患者随访3个月至1年2个月。除1例皮瓣臃肿外，其余皮瓣外观及质地良好。皮瓣感觉基本恢复至S2-S3。手部功能恢复良好。
腹壁双叶皮瓣可用于修复手掌、手背及前臂皮肤软组织缺损，因其具有皮源面积大、血供充足等优点。此外，该手术实用、安全、简便。
