Voigt M, Schaefer D J, Stark G B
Abteilung Plastische und Handchirurgie, Chirurgische Universitätsklink, Hugstetter Straße 56 D-79103, Freiburg.
Oper Orthop Traumatol. 1999 Sep;11(3):183-96. doi: 10.1007/BF02593979.
Coverage of a soft tissue defect at the hand with a pedicled fasciocutaneous flap.
Primary or secondary skin and soft tissue defects of the hand of less than 15×5 cm.
Absent posterior interosseous artery. Absent anastomosis between posterior and anterior interosseous arteries. Defects smaller than 3×3 cm; they should be closed through mobilization of the surrounding tissues.
Marking of flap. The first skin incision is done at the ulnar side of the marked flap and deepened to the fascia of the extensor carpi ulnaris muscle. Dissection of the intermuscular septum while preserving the perforating skin vessels of posterior interosseous artery. Incision at the radial side and dissection of the intermuscular septum from radial without injuring the motor branches of the radial nerve. Ligation of the posterior interosseous artery distal to the motor branches. Detachment of the pedicle through coagulation of the branches going to muscles and bone. Detachment of the intermuscular septum from ulnar. Exposure of the communication with the anterior interosseous vessels. Spreading and tensionless suturing of flap into the defect. Avoid kinking of defect. Primary closure of the site of harvesting or coverage with full or split thickness skin graft.
During a period of 3.5 years this technique was used in 10 patients. The average time to healing: 15.9 days. Average duration of follow-up: 19.1 months. All flaps were incorporated. The only complication was a venous congestion in the flap in 2 patients.
用带蒂筋膜皮瓣覆盖手部软组织缺损。
手部原发性或继发性皮肤及软组织缺损，面积小于15×5cm。
骨间后动脉缺如。骨间后动脉与骨间前动脉之间无吻合。缺损小于3×3cm；此类缺损应通过周围组织的游离来闭合。
皮瓣标记。在标记皮瓣的尺侧做第一道皮肤切口并向尺侧腕伸肌筋膜深层延伸。在保留骨间后动脉穿支皮血管的同时切开肌间隔。在桡侧做切口并从桡侧切开肌间隔，避免损伤桡神经运动支。在运动支远侧结扎骨间后动脉。通过凝固至肌肉和骨骼的分支来离断蒂部。从尺侧离断肌间隔。暴露与骨间前血管的交通支。将皮瓣展开并无张力缝合至缺损处。避免皮瓣扭转。供区一期缝合或用全厚或中厚皮片覆盖。
在3.5年的时间里，该技术应用于10例患者。平均愈合时间：15.9天。平均随访时间：19.1个月。所有皮瓣均成活。仅2例患者出现皮瓣静脉淤血这一并发症。
