Wang Howard D, Alonso-Escalante Jose C, Cho Brian H, DeJesus Ramon A
Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, United States.
Division of Plastic, Maxillofacial, and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, United States.
J Hand Microsurg. 2017 Aug;9(2):58-66. doi: 10.1055/s-0037-1603918. Epub 2017 Jun 27.
The goals of upper extremity soft tissue reconstruction should go well beyond providing coverage and restoring function. As the field of reconstructive microsurgery has evolved, free cutaneous flaps (FCFs) are gaining wider application. The advantages of FCF include minimizing donor-site morbidity by preserving the muscle and fascia, improving versatility of flap design, and superior aesthetic results. This review highlights the application of anterolateral thigh, superficial circumflex iliac artery, deep inferior epigastric perforator, superficial inferior epigastric artery, and flow-through flaps for reconstruction of upper extremity defects. These flaps share several qualities in common: well-concealed donor sites, preservation of major arteries responsible of providing inflow to distal extremity, and potential for a two-team approach (donor and recipient sites). While the choice of flaps should be decided based on individual patient and defect characteristics, FCF should be considered as excellent options to achieve the goals of upper extremity reconstruction.
上肢软组织重建的目标应远不止于提供覆盖和恢复功能。随着重建显微外科学领域的发展，游离皮瓣（FCF）的应用越来越广泛。游离皮瓣的优点包括通过保留肌肉和筋膜将供区并发症降至最低、提高皮瓣设计的灵活性以及获得更好的美学效果。本综述重点介绍了股前外侧皮瓣、旋髂浅动脉皮瓣、腹壁下深动脉穿支皮瓣、腹壁下浅动脉皮瓣以及穿流皮瓣在上肢缺损重建中的应用。这些皮瓣具有几个共同特点：供区隐蔽、保留负责向远端肢体供血的主要动脉以及有可能采用双组手术方式（供区和受区同时进行手术）。虽然皮瓣的选择应根据患者个体情况和缺损特点来决定，但游离皮瓣应被视为实现上肢重建目标的理想选择。
