变异型前臂骨间背逆行岛状皮瓣的临床应用  

The clinical experience of reverse posterior interosseous artery island flap with vascular variations

作　　者：许亚军[1] 陈政[1] 包岳丰[1] 周晓[1] 张辉[1] 周建东[1] 陈学明[1] 

机构地区：[1]无锡市手外科医院显微外科,214062

出　　处：《中华手外科杂志》2013年第6期344-347,共4页Chinese Journal of Hand Surgery

摘　　要：目的介绍前臂骨问背逆行岛状皮瓣的血管变异类型及处理体会。方法1990年至2012年我科共开展前臂骨间背逆行岛状皮瓣400余例，对其中属于血管变异的30例进行回顾分析，认为血管变异有以下类型：骨间背动脉弥散细弱无明确终末支，也无明显皮支进入皮瓣，由骨问背动脉起始发出穿支，自皮瓣近侧进入14例；骨间背动脉弥散细弱无明确终末支，也无明显皮支进入皮瓣，由骨问前动脉在前臂近1／3桡侧腕伸肌、指总伸肌间隙发出穿支8例；骨间背动脉缺失，由骨问前动脉在前臂中远1／3交界拇长伸肌、指总伸肌间隙发出粗大穿支8例。结果属于血管变异的前臂骨间背逆行岛状皮瓣共30例，术后24例完全顺利存活；4例近侧皮支型皮瓣出现静脉血流受限，拆除蒂部缝线后顺利存活，2例桡侧皮支代偿型皮瓣远蒂端约1／3干性坏死，予扩创肉芽生长良好后取全厚皮片植皮修复。20例获得3～6个月的随访，皮瓣外观满意，供区植皮愈合，未出现骨间背神经损伤并发症。结论正确认识前臂骨间背逆行岛状皮瓣的血管变异类型有助于避免手术放弃并提高手术的成功率。Objective To introduce the clinical experience to harvest reverse-flow posterior interosseous artery forearm island flaps when there exists vascular variation. Methods A total of 400 cases of forearm reverse island flap pedicled with antebraehial branch of the posterior interosseous artery carried out in our department from 1990 to 2012 were summarized. Vascular variations existed in 30 eases which were retrospectively analyzed. These variations included the following types. Instead of giving off a dominant terminal branch, the posterior intemsseous artery was thin and diffused distally. There was no obvious cutaneous branch into the flap. The perforators took off at the beginning of the posterior interosseons artery and entered the flaps proximally. This vascular variation occurred in 14 cases. The posterior intemsseous artery had no dominant terminal branch and no cutaneous branch into the flap. The perforators took off at the proximal 1/3 forearm level and coursed between extensor carpi radialis and extensor digitorum comminns in 8 eases. In the third vascular variation the posterior intemsseons artery was absent. The anterior intemsseons artery gave off a thick perforator at the jtmetion of middle and distal 1/3 of the forearm level between extensor hallueis longus and extensor digitorum eomminus. This variation occurred in 8 cases. Results There were 30 eases that had vascular variation of the posterior interosseous artery. Complete survival and primary healing were seen in 24 flaps. Venous drainage compromise occurred in 4 flaps with the proximal perforator variation. Removal of the stitches at the pedicle rescued the flaps. There was partial distal necrosis in 2 flaps with the radial cutaneous branch variation. Healing occurred after full thickness skin grafting. Of the 30 eases, 20 had 3 to 6 months follow-up. Appearance of the flaps was satisfactory. The donor site skin graft healed uneventfully. There were no complications with the posterior intemsseous nerve. Conclusion Correct understanding of vascula

关 键 词：岛状皮瓣 外科手术 血管变异 

分 类 号：R658.2[医药卫生—外科学]