Dr Avijit Sarker, Registrar, Department of Burn & Plastic Surgery, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2024 Jul;33(3):772-776.
Soft tissue injuries of the hand or forearm often results in exposure of tendon or bone which needs coverage with a suitable flap. This prospective observational study was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from February 2019 to January 2020, to evaluate the use of the pedicled paraumbilical perforator flaps as a reliable flap to cover such defects. Total 34 patients having soft tissue defects in the hand and forearm with exposed tendons, bones or implant were included in this study. All the defects were covered by paraumbilical perforator flap. The defects were caused by road traffic accident (n=22), machinery injury (n=10) and burn injury (n=2). Sixteen patients had defects involving the forearm, six over dorsum of hand, another two over first web space and the rest had defects over two or more areas of forearm, hand and wrist. Lateral extent of flaps was upto anterior axillary line in 41.18% cases and upto mid-axillary line in 55.88% cases. Flap division and final inset was done in second stage after 3 weeks. Donor site closed primarily in all cases, except in two cases where it was covered by skin graft. All the flaps survived with no incidence of flap necrosis, dehiscence or infection after first stage. However, after the division of the flap, two patients developed marginal necrosis of the proximal margin which healed spontaneously by conservative treatment. The mean flap surface area utilized was 108 cm2. Donor area healed well without any major complications. Three patients developing scar hypertrophy were treated with intra-lesional triamcinolone injections. The paraumbilical perforator flap is a reliable option to cover soft tissue defects of hand and forearm due to easier planning and harvesting of the flap, adequate skin paddle and minimum donor site morbidity.
手部或前臂的软组织损伤常导致肌腱或骨骼外露，需要用合适的皮瓣覆盖。本前瞻性观察研究于 2019 年 2 月至 2020 年 1 月在孟加拉国达卡的国家创伤和矫形康复研究所（NITOR）进行，旨在评估使用带蒂脐旁穿支皮瓣作为覆盖此类缺损的可靠皮瓣。本研究共纳入 34 例手部和前臂有肌腱、骨骼或植入物外露的软组织缺损患者。所有缺损均采用脐旁穿支皮瓣覆盖。这些缺损是由道路交通伤（n=22）、机器伤（n=10）和烧伤（n=2）引起的。16 例患者的缺损累及前臂，6 例位于手背，另外 2 例位于第一手掌间隙，其余患者的缺损累及前臂、手和腕部两个或更多区域。皮瓣的外侧范围在 41.18%的病例中达腋前线，在 55.88%的病例中达腋中线。皮瓣分离和最终植皮在第 3 周后分两期进行。所有患者的供区均一期直接缝合，仅 2 例患者因供区面积较大而采用皮片移植覆盖。所有皮瓣均存活，第 1 期无皮瓣坏死、裂开或感染。然而，皮瓣分离后，有 2 例患者近端边缘出现边缘性坏死，经保守治疗后自行愈合。平均使用皮瓣面积为 108cm2。供区愈合良好，无重大并发症。3 例发生瘢痕增生的患者采用皮内曲安奈德注射治疗。脐旁穿支皮瓣是覆盖手部和前臂软组织缺损的可靠选择，因为其皮瓣的规划和采集更容易、皮瓣面积足够大、供区并发症少。
