Sağır Mehmet, Güven Erdem, Cerci Ozkan Aret, Kozanoğlu Erol
Department of Plastic Reconstructive and Aesthetic Surgery, Privete Maslak Acıbadem Hospital, İstanbul-Türkiye.
Specialist of Plastic Reconstructive and Aesthetic Surgery, Private Practice, İstanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2023 Oct 27;29(11):1296-1302. doi: 10.14744/tjtes.2023.62186.
The radial forearm flap is one of the most commonly used flaps of reconstructive microsurgery with its long pedicle and thin structure. The donor site at the forearm is a visible anatomic region that has high mobility and functional importance. In this study, a longitudinal and large scar was avoided on the forearm during pedicle dissection of the conventional radial forearm flap with the utilization of an endoscope. Furthermore, arterial, venous, and nervous injuries were avoided by performing a separate inci-sion of 2-3 cm at the cubital fossa to reduce flap failure and donor site morbidity.
The patients who underwent pedicle dissection of the radial forearm flap with the aid of an endoscope for head-neck reconstruction between 2014 and 2021 were included in this study. The flap was harvested from the subfascial plane. The cephalic vein was used in all of the patients. When the pedicle dissection reached the antecubital region, an incision of 2-3 cm was performed from the skin. Two vein anastomoses were performed for each patient.
This retrospective study consists of 51 patients. While 45 of the patients were the result of head and neck cancer, six of them had a defect caused by trauma. The average area of skin islands was 40.3 cm2, while the full-thickness skin graft size was 24.2 cm2. An average of 2.6 cm of scar tissue was formed at the antecubital region. No venous or arterial compromise was observed in the post-operative period. There was no partial or total flap loss in any patient. Localized numbness persisted in the skin area where the superficial sensory branch of the radial nerve is located in 6 (11.7%) patients.
With endoscopic radial forearm flap harvesting, the longitudinal incision in the forearm and wound healing prob-lems are avoided. The absence of partial or total flap loss has shown that endoscopic harvesting of the radial forearm flap is a safe and reliable method.
前臂桡侧皮瓣是重建显微外科中最常用的皮瓣之一，其蒂长且结构薄。前臂的供区是一个可见的解剖区域，具有较高的活动度和功能重要性。在本研究中，利用内窥镜在前臂桡侧皮瓣的蒂部解剖过程中避免了在前臂形成纵向大瘢痕。此外，通过在肘窝处单独做一个2 - 3厘米的切口，避免了动脉、静脉和神经损伤，以减少皮瓣坏死和供区并发症。
本研究纳入了2014年至2021年间借助内窥镜进行前臂桡侧皮瓣蒂部解剖以进行头颈部重建的患者。皮瓣从筋膜下平面切取。所有患者均使用头静脉。当蒂部解剖到达肘前区域时，从皮肤做一个2 - 3厘米的切口。每位患者进行了两处静脉吻合。
这项回顾性研究包括51例患者。其中45例患者是头颈部癌症的结果，6例患者有创伤导致的缺损。皮岛平均面积为40.3平方厘米，全厚皮片大小为24.2平方厘米。肘前区域平均形成2.6厘米的瘢痕组织。术后未观察到静脉或动脉受压情况。没有任何患者出现部分或全部皮瓣丢失。6例（11.7%）患者桡神经浅感觉支所在皮肤区域持续存在局部麻木。
采用内窥镜切取前臂桡侧皮瓣，避免了前臂的纵向切口和伤口愈合问题。未出现部分或全部皮瓣丢失表明内窥镜切取前臂桡侧皮瓣是一种安全可靠的方法。
