Dibbs Rami, Grome Luke, Pederson William C
Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.
Semin Plast Surg. 2019 Feb;33(1):17-23. doi: 10.1055/s-0039-1677702. Epub 2019 Mar 8.
With the advent of the Industrial Revolution, traumatic injuries of the upper extremity increased exponentially. As a result, surgeons began to reevaluate amputation as the standard of care. Following the Second World War, local and regional pedicled flaps became common forms of traumatic upper extremity reconstruction. Today, microsurgery offers an alternative when options lower on the reconstructive ladder have been exhausted or will not produce a desirable result. In this article, the authors review the use of free tissue transfer for upper extremity reconstruction. Flaps are categorized as fasciocutaneous, muscle, and functional tissue transfers. The thin pliable nature of fasciocutaneous flaps makes them ideal for aesthetically sensitive areas, such as the hand. The radial forearm, lateral arm, scapula, parascapular, anterolateral thigh, and temporoparietal fascia flaps are highlighted in this article. Muscle flaps are utilized for their bulk and size; the latissimus dorsi flap serves as a "workhorse" free muscle flap for upper extremity reconstruction. Other muscle flaps include the rectus abdominis and serratus anterior. Lastly, functional tissue transfers are used to restore active range of motion or bony integrity to the upper extremity. The innervated gracilis can be utilized in the forearm to restore finger flexion or extension. Transfer of vascularized bone such as the fibula may be used to correct large defects of the radius or ulna. Finally, replacement of "like with like" is embodied in toe-to-thumb transfers for reconstruction of digital amputations.
随着工业革命的到来，上肢创伤性损伤呈指数级增长。因此，外科医生开始重新评估截肢作为标准治疗方法。第二次世界大战后，局部和区域带蒂皮瓣成为上肢创伤重建的常见形式。如今，当重建阶梯上较低级别的选择已经用尽或无法产生理想结果时，显微外科手术提供了一种替代方案。在本文中，作者回顾了游离组织移植在上肢重建中的应用。皮瓣分为筋膜皮瓣、肌皮瓣和功能性组织移植。筋膜皮瓣薄而柔韧的特性使其非常适合手部等对美观要求较高的区域。本文重点介绍了桡侧前臂皮瓣、上臂外侧皮瓣、肩胛皮瓣、肩胛旁皮瓣、股前外侧皮瓣和颞顶筋膜皮瓣。肌皮瓣因其体积和大小而被利用；背阔肌皮瓣是上肢重建中常用的游离肌皮瓣。其他肌皮瓣包括腹直肌皮瓣和前锯肌皮瓣。最后，功能性组织移植用于恢复上肢的主动活动范围或骨完整性。带神经的股薄肌可用于前臂以恢复手指的屈伸。如腓骨等带血管蒂骨的移植可用于纠正桡骨或尺骨的大缺损。最后，“以相似组织替代相似组织”体现在用于手指截肢重建的足趾-拇指移植中。
