Weinzweig N, Chen L, Chen Z W
Division of Plastic Surgery, University of Illinois at Chicago.
Plast Reconstr Surg. 1994 Oct;94(5):675-84. doi: 10.1097/00006534-199410000-00016.
The axial-pattern reverse radial forearm fasciocutaneous flap has become one of the primary flaps for reconstruction of soft-tissue defects of the hand. The two main disadvantages of this flap are (1) sacrifice of a major artery that may possibly jeopardize hand viability and (2) morbidity and appearance of the donor site. In an effort to overcome these drawbacks, an anatomic study of a distally based radial forearm fasciosubcutaneous flap with preservation of the radial artery was conducted. Seventeen fresh cadaver forearms were dissected to investigate the contribution of the distal radial artery and its superficial and deep branches to the fasciosubcutaneous plexus of the forearm. The blood supply to the radial forearm fasciosubcutaneous tissue was found to emanate from 6 to 10 septocutaneous perforators of the distal radial artery in the vicinity of the anatomic snuff box that "fan out" at the level of the deep fascia to form a rich plexus supplying the forearm fascia, subcutaneous tissue, and skin. There appeared to be a definite directional component, with the arterioles running longitudinally along the intermuscular septum. The deep fascia and subcutaneous tissue were found to have their own venous system accompanying the small perforating arterioles. Encouraged by these findings, we proceeded to utilize this fasciosubcutaneous flap for coverage of the thumb-index web space (three patients), the dorsum of the hand (two patients), and both the palmar and dorsal aspects of the hand (one patient). Five flaps had almost complete survival. The largest flap in our series suffered significant loss. Minor skin-graft loss occurred in a few cases, and we now delay skin grafting for several days. The distally based radial forearm fasciosubcutaneous flap with preservation of the radial artery can be a very useful and reliable alternative for repairing soft-tissue defects of the hand, obviating the need for the classic fasciocutaneous flap or even a free flap. This flap not only preserves the radial artery, which is essential in cases where only the radial artery is functioning, such as following severe hand injuries, but also provides a more acceptable donor site.
轴型逆行桡侧前臂筋膜皮瓣已成为手部软组织缺损重建的主要皮瓣之一。该皮瓣的两个主要缺点是：（1）牺牲一条主要动脉，这可能会危及手部的存活能力；（2）供区的发病率和外观问题。为了克服这些缺点，我们进行了一项保留桡动脉的远端蒂桡侧前臂筋膜皮下瓣的解剖学研究。解剖了17例新鲜尸体的前臂，以研究桡动脉远端及其浅、深分支对前臂筋膜皮下丛的供血情况。发现桡侧前臂筋膜皮下组织的血液供应来自桡动脉远端在解剖鼻烟窝附近的6至10个隔皮穿支，这些穿支在深筋膜水平呈“扇形散开”，形成一个丰富的丛，为前臂筋膜、皮下组织和皮肤供血。似乎存在一个明确的方向性成分，小动脉沿肌间隔纵向走行。发现深筋膜和皮下组织有自己的静脉系统，与小穿支动脉伴行。受这些发现的鼓舞，我们开始使用这种筋膜皮下瓣覆盖拇指-示指指蹼间隙（3例患者）、手背（2例患者）以及手掌和手背（1例患者）。5个皮瓣几乎完全存活。我们系列中最大的皮瓣出现了明显的坏死。少数病例出现了轻微的植皮丢失，我们现在会将植皮推迟几天。保留桡动脉的远端蒂桡侧前臂筋膜皮下瓣可以是修复手部软组织缺损非常有用且可靠的替代方法，无需使用经典的筋膜皮瓣甚至游离皮瓣。这种皮瓣不仅保留了桡动脉，在仅桡动脉发挥作用的情况下（如严重手部损伤后）至关重要，而且提供了一个更易接受的供区。
