Partecke B D, Buck-Gramcko D
J Reconstr Microsurg. 1984 Jul;1(1):1-6. doi: 10.1055/s-2007-1007046.
The free forearm flap is an accepted procedure for covering defects due to osteitis in the lower leg. End-to-end anastomoses have usually been preferred, if the diameters of the donor and recipient arteries are more or less equal. However, if one or more arteries of the lower leg are absent, end-to-end anastomosis is not indicated, because further disturbances of blood circulation will ensue. We present a procedure in which the flap vessels act as an arterial and venous bypass, thus improving the circulation in the lower leg, while concurrently perfusing the flap. Following full thickness skin graft, cosmetic results at the donor site are not especially pleasing. Results can be improved by a split skin graft (used as a mesh graft), and by situating the donor site on the upper third of the forearm. At the recipient site, the flap can be infolded and connected in anatomic right or reverse directions, depending on the required length of the flap vascular pedicle needed for reconstruction. This can lead to a reverse blood flow in he vessels of the transferred free forearm flap. The radial artery can be restored by vein graft from the same forearm. In 25 free forearm flaps to the lower leg, arterial bypass was performed in 14 cases, venous bypass as well in four cases, with reverse blood flow in three cases.
游离前臂皮瓣是用于覆盖小腿骨炎所致缺损的一种公认术式。如果供体和受体动脉直径大致相等，通常更倾向于采用端端吻合术。然而，如果小腿的一条或多条动脉缺失，则不适合进行端端吻合，因为这会导致进一步的血液循环障碍。我们介绍一种术式，其中皮瓣血管起到动静脉旁路的作用，从而改善小腿的血液循环，同时为皮瓣灌注。在进行全厚皮片移植后，供区的美容效果并不特别理想。采用中厚皮片移植（用作网状移植）以及将供区置于前臂上三分之一处可改善效果。在受区，可根据重建所需皮瓣血管蒂的长度，将皮瓣向内折叠并按解剖学正向或反向连接。这可能导致移植的游离前臂皮瓣血管出现反向血流。桡动脉可通过取自同一条前臂的静脉移植进行修复。在25例用于小腿的游离前臂皮瓣手术中，14例进行了动脉旁路手术，4例同时进行了静脉旁路手术，3例出现反向血流。
