前臂外侧皮神经-头静脉营养血管筋膜皮瓣供区并发症分析  

Radial forearm neurovenofasciocutaneous flap donor-site complications and morbidity

作　　者：王绥江[1] 罗少军[1] 金玉丹[1] 汤少明[1] 梁杰[1] 吕端远[2] 

机构地区：[1]广东医学院附属医院整形外科研究所,广东湛江524001 [2]广东医学院人体解剖学教研室,广东湛江524023

出　　处：《中国临床解剖学杂志》2007年第6期702-704,共3页Chinese Journal of Clinical Anatomy

基　　金：广东省千百十工程资助项目(9951)

摘　　要：目的:分析前臂外侧皮神经-头静脉营养血管筋膜皮瓣供区并发症,评价该皮瓣临床应用价值。方法:术前对手部握力、捏力和前臂旋转及腕关节活动范围进行评定。于术后第7d、3周和3个月观察并记录手部和腕部肿胀程度,第7d测量记录植皮成活面积。3周后进行前臂外侧皮神经、桡神经浅支分布区域皮肤浅感觉评定。3个月后对手部握力、捏力和前臂旋转及腕关节活动范围进行评定并与术前对比。3个月后进行供区外观评定,要求患者主观评价其满意程度,最后归纳为满意,一般和不满意3个等级。结果:实施手术29例,其中22例获随访,随访时间6～48月。供区并发症包括前臂外侧皮神经分布区域异常(100%)、桡神经浅支分布区感觉异常(9.1%)、皮片部分坏死(18.1%)、供区外观不满意(45.5%)和供侧手部和腕部肿胀等,而前臂旋转活动和腕关节屈、伸、收、展活动与术前相比均无统计学意义。结论:供区皮肤感觉功能障碍和供区植皮外观不满意是该类皮瓣供区主要并发症,而供侧手部、腕部活动功能不受影响。Objective： To investigate the donor-site complications and morbidity of neurovenofasciocutaneous flap in radial forearm. Methods： Patients underwent radial forearm neurovenofasciocutaneous flap reconstruction in hands and faces were evaluated for accessing donor-site complications and morbidity. Postoperatively, we examined the wrist and hand circumference at the 7th day, the 4th week and the 3rd month, and calculated the percentage of skin graft failure at the 7th day. At the 3rd month, the shape of donor site, the function of antebrachi lateral cutaneous nerve and superficial branch of radial nerve were evaluated. Grip strength, pinch strength, the movement of forearm and wrist were measured preoperatively and at the third week postoperatively, and statistically compared. Resttlts： 22 of 29 patients followed up from 6 to 48 months were included in this study. The complications concemed with dysesthesia happened in the distribution area of antebrachi lateral cutaneous nerve （100%） and of superficial branch of radial nerve （9.1%）, skin graft failure （18.1%）, poor aesthetic appearances （22.7%）, and the swollen hand and/or wrist. Regarding to grip strength, pinch strength, the range of movement of forearm and wrist, there was no statistical significance before and after operation. Conclt^ons： The complications in flap donor-site only deal with the sensory functional impairment and the unsatisfied appearance of it. The movement of hand and wrist is intact.

关 键 词：前臂 外科皮瓣 皮神经营养血管皮瓣 供区 并发症 

分 类 号：R622.1[医药卫生—整形外科] R619[医药卫生—外科学]