Chen H C, Cheng M H, Schneeberger A G, Cheng T J, Wei F C, Tang Y B
Department of Surgery at Chang Gung Memorial Hospital, Taipei, Taiwan.
J Trauma. 1998 Sep;45(3):570-4. doi: 10.1097/00005373-199809000-00027.
Conventional posterior interosseous flap has the disadvantage of partial or even complete necrosis of the flap when there is anatomical variation or contusion around its distal pedicle. To make it a more reliable flap, three types of auxiliary procedures were designed.
(1) When there is congestion after inset of the distally based flap, an additional venous anastomosis was carried out. (2) When there is anatomical variation so that a distally based flap could not be raised without compromising the nerve branches, or when contusion was found around the distal pedicle, the flap was changed into a free flap. This design is also indicated for coverage of the distal fingers. (3) When the patient is elderly with possible peripheral arterial disease, the flap was raised with a wide base, incorporating the branches of both the anterior and posterior interosseous arteries. There were eight, 36, and five patients in each group, respectively.
There was only one failure in the free flap group. No partial necrosis of the flap was found. Other complications were analyzed.
With these backup procedures, the posterior interosseous flap can be more widely used with safety. By combining various reconstructive armaments, the result of a conventional procedure can be improved.
传统的骨间后动脉皮瓣存在缺点，即当皮瓣远端蒂部周围存在解剖变异或挫伤时，皮瓣可能会部分甚至完全坏死。为了使其成为更可靠的皮瓣，设计了三种辅助手术方法。
（1）当远端蒂皮瓣植入后出现淤血时，进行额外的静脉吻合。（2）当存在解剖变异，导致在不损伤神经分支的情况下无法掀起远端蒂皮瓣时，或当在远端蒂部周围发现挫伤时，将皮瓣改为游离皮瓣。这种设计也适用于覆盖远端手指。（3）当患者为老年人且可能患有周围动脉疾病时，以较宽的蒂部掀起皮瓣，纳入骨间前动脉和骨间后动脉的分支。每组分别有8例、36例和5例患者。
游离皮瓣组仅1例失败。未发现皮瓣部分坏死。分析了其他并发症。
通过这些备用手术方法，骨间后动脉皮瓣可以更安全地广泛应用。通过结合各种重建手段，可以改善传统手术的效果。
