Chow J A, Bilos Z J, Hui P, Hall R F, Seyfer A E, Smith A C
Plast Reconstr Surg. 1986 Mar;77(3):421-6. doi: 10.1097/00006534-198603000-00014.
The historical literature of the use of axial vascular pattern flaps from the hypogastric and iliofemoral regions in reparative surgery of the hand is concisely reviewed. Thirty-six iliofemoral (groin) flaps were utilized for delayed primary resurfacing and secondary reconstruction of defects of the hand and forearm. Two flaps (6 percent) were complicated by partial necrosis. We caution against the immediate resurfacing (within 24 hours of injury) of acute crushed hand wounds by distant flaps. The immediate application of a healthy flap on a soiled or crushed wound invites complications of local tissue necrosis, infection, and subsequent loss of the flap. When distant flaps are indicated for coverage of acute hand wounds, delayed primary coverage following complete removal of all nonviable tissue is a safe and reliable regimen. It is advantageous to design the serviceable portion of the flap on the distal area of the vascular territory of the groin flap. Thoughtful yet "radical" defatting can be performed on the lateral portion of the groin flap territory. Constructed in this way, the long medial base of the groin flap allows freedom for movement at the wrist and metacarpophalangeal and interphalangeal joints, thus decreasing edema and stiffness. In the management of soft-tissue defects in the hand requiring distant flap coverage, we choose to utilize the conventional groin flap in preference to the microvascular free flap when both techniques will deliver equal results.
本文简要回顾了在手部修复手术中使用来自下腹和髂股区域的轴型血管皮瓣的历史文献。三十六例髂股（腹股沟）皮瓣用于手部和前臂缺损的延迟一期修复及二期重建。两例皮瓣（6%）出现部分坏死并发症。我们提醒不要用远位皮瓣对急性挤压伤的手部伤口进行即刻修复（伤后24小时内）。在污染或挤压伤的伤口上即刻应用健康皮瓣会引发局部组织坏死、感染及随后皮瓣丢失等并发症。当需要用远位皮瓣覆盖急性手部伤口时，在彻底清除所有失活组织后进行延迟一期覆盖是一种安全可靠的方案。将皮瓣的可用部分设计在腹股沟皮瓣血管区域的远端是有利的。可以对腹股沟皮瓣区域的外侧部分进行精心但“彻底”的去脂操作。以这种方式构建的腹股沟皮瓣长内侧蒂，可使腕关节、掌指关节和指间关节自由活动，从而减轻水肿和僵硬。在处理手部需要远位皮瓣覆盖的软组织缺损时，当两种技术效果相当时，我们选择使用传统腹股沟皮瓣而非游离微血管皮瓣。
