Shonka David C, Kohli Nikita V, Milam Benjamin M, Jameson Mark J
1 Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Ann Otol Rhinol Laryngol. 2017 Mar;126(3):224-228. doi: 10.1177/0003489416685322. Epub 2017 Jan 6.
To determine if suprafascial harvest of the radial forearm free flap improves postoperative donor site outcomes compared to subfascial harvest.
Retrospective chart review.
Forty-six patients underwent reconstruction of a head and neck defect with a radial forearm free flap (RFFF). Subfascial harvest of the RFFF was performed in 25 (53%) patients and suprafascial harvest performed in 22 (47%) patients. All donor sites were covered with a split thickness skin graft and a bolster that remained in place for 6 days. Postoperative tendon exposure at the donor site occurred in 5 (20%) of the patients in the subfascial group and in 0 (0%) of the patients in the suprafascial group ( P = .05; Fisher's exact test). Average tourniquet time was 117 minutes in the subfascial group and 102 minutes in the suprafascial group. Hematoma formation occurred at the donor site in 2 (8%) and 1 (5%) patients in the subfascial and suprafascial groups, respectively. There were no complete or partial flap losses in either group.
Suprafascial harvest of the RFFF decreases the risk of postoperative tendon exposure. The suprafascial harvest technique does not increase harvest time or donor site complications, nor does it negatively impact flap vascularity.
确定与筋膜下切取相比，桡侧前臂游离皮瓣的筋膜上切取是否能改善术后供区结局。
回顾性病历审查。
46例患者接受了桡侧前臂游离皮瓣（RFFF）修复头颈部缺损。25例（53%）患者采用筋膜下切取RFFF，22例（47%）患者采用筋膜上切取。所有供区均用断层皮片覆盖并放置敷料6天。筋膜下组5例（20%）患者供区术后出现肌腱外露，筋膜上组0例（0%）患者出现（P = 0.05；Fisher精确检验）。筋膜下组平均止血带时间为117分钟，筋膜上组为102分钟。筋膜下组和筋膜上组分别有2例（8%）和1例（5%）患者供区出现血肿形成。两组均未出现皮瓣完全或部分坏死。
RFFF的筋膜上切取可降低术后肌腱外露的风险。筋膜上切取技术不会增加切取时间或供区并发症，也不会对皮瓣血运产生负面影响。
