Zhengyang Gao, Canhua Jiang, Jie Chen, Limeng Wu, Hui Ren, Fuqiang Long, Chunrui He, Xinchun Jian
Dept. of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.
Hua Xi Kou Qiang Yi Xue Za Zhi. 2016 Oct 1;34(5):478-482. doi: 10.7518/hxkq.2016.05.009.
This study aims to investigate the feasibility and clinical application value of a new method for primary donor-site closure of radial forearm flaps with the use of rotation and advancement of radial-based fasciocutaneous flaps.
METHODS: The forearm donor-site defects of 36 patients were primarily closed by rotation and advancement of radial-based fasciocutaneous flaps after radial flap harvest from November 2014 to May 2015. Patients included 28 males and 8 females aged 28 to 67 years (53.6 years old on average). Flap size ranged from 3.0 cm×5.0 cm to 4.0 cm×6.0 cm. Wound healing, scar hyperplasia, and forearm appearance were recorded and evaluated. Wrist flexion angle, dorsal extension angle, ulnar deviation angle, and radial deviation angle were measured three and six months after the operation. Wrist joint loss index was calculated and compared with the preoperative index to evaluate wrist function recovery. The results were subjected to comparative t- test to perform statistical analysis with SPSS 19.0 statistical software package.
Forearm donor sites were successfully closed without skin grafting in all patients. Skin ischemia caused by excessive tension was observed at the incision edge in five cases, thereby leading to skin exfoliation and pigment loss without affecting wound healing. All patients were followed up at six and twelve months, and presented a satisfactory appearance. No scar hyperplasia was observed. No significant difference was observed in radial deviation, ulnar deviation, palmar flexion, dorsiflexion, radial deflection angle, or wrist joint loss index (P>0.05) after the operation.
Application of rotation and advancement of radial-based fasciocutaneous flaps can directly close small-to-medium radial forearm flap donor defects. Satisfactory postoperative appearance can be achieved with no loss in wrist joint function. The novel method prove worthy of promotion and application in clinical work.
本研究旨在探讨采用基于桡侧的筋膜皮瓣旋转推进法对桡侧前臂皮瓣供区进行一期关闭的新方法的可行性及临床应用价值。
2014年11月至2015年5月，对36例患者在切取桡侧皮瓣后，采用基于桡侧的筋膜皮瓣旋转推进法对前臂供区缺损进行一期关闭。患者包括28例男性和8例女性，年龄28至67岁（平均53.6岁）。皮瓣大小为3.0 cm×5.0 cm至4.0 cm×6.0 cm。记录并评估伤口愈合情况、瘢痕增生情况及前臂外观。在术后3个月和6个月测量腕关节屈曲角度、背伸角度、尺偏角度和桡偏角度。计算腕关节功能丧失指数并与术前指数进行比较，以评估腕关节功能恢复情况。结果采用成组t检验，使用SPSS 19.0统计软件包进行统计分析。
所有患者的前臂供区均成功关闭，无需植皮。5例患者在切口边缘出现因张力过大导致的皮肤缺血，进而出现皮肤脱落和色素脱失，但未影响伤口愈合。所有患者均在术后6个月和12个月进行随访，外观满意。未观察到瘢痕增生。术后桡偏、尺偏、掌屈、背伸、桡偏角度或腕关节功能丧失指数均无显著差异（P>0.05）。
采用基于桡侧的筋膜皮瓣旋转推进法可直接关闭中小型桡侧前臂皮瓣供区缺损。术后外观满意，腕关节功能无丧失。该新方法值得在临床工作中推广应用。
