前臂近端橈侧肘下动脉穿支皮瓣修复肘前创面  

Using the forearm proximal radial inferior cubital artery perforator flap to repair the wound defectsof anterior elbow

作　　者：林涧[1] 吴立志 张天浩[1] 王之江[1] 郑和平[3] Lin Jian;Wu Lizhi;Zhang Tianhao;Wang Zhijiang;Zheng Heping(Department of Microsurgery,Xinhua Hospital(Chongming)Affiliated to Medical College,Shanghai Jiaotong University f Shanghai 202150,China;Department of Microsurgery,Taizhou Hospital Affiliated to Wenzhou Medical Universityy Taizhou 318050,China;Bengbu Medical College,Affiliated Fuzhou General Hospital of Nanjing Command,PLA,Fuzhou 353000,China)

机构地区：[1]上海交通大学医学院附属新华医院(崇明)骨、显微外科,202150 [2]温州医科大学附属浙江省台州医院手显微外科,318O5O [3]蚌埠医学院福总教学医院(南京军区福州总医院)骨科研究所,353000

出　　处：《中华整形外科杂志》2019年第11期1090-1095,共6页Chinese Journal of Plastic Surgery

基　　金：上海市科研计划项目(14411973200);上海市卫计委科研课题(201840198);浙江省台州市科技计划项目(1801kyll)。

摘　　要：目的探讨前臂近端挠侧肘下动脉穿支皮瓣移位修复肘前缺损创面的可行性。方法采用回顾性系列研究分析2013年6月至2018年6月收治的11例肘前皮肤软组织缺损患者临床资料,其中男8例,女3例,年龄48-76岁,平均51.5岁。肘前缺损创面最大为14 cmx7 cm,最小7.5 cmx4.5 cmo根据肘前缺损创面的位置、大小、形状,在前臂中上段设计并切取前臂近端橈侧肘下动脉穿支皮瓣,转位修复肘前创面,皮瓣最大面积为15 cmXlO cm,最小面积为7 cmx5 cmo根据皮瓣成活、弹性、色泽、外观形态、感染控制、供区瘢痕、皮肤感觉、肘关节活动、患者认可度等,综合评价术后疗效;参照Mayo标准对肘部功能进行评价;按照4级判断标准对所有皮瓣进行肿胀程度评定。结果术后11例皮瓣完全成活,创面一期愈合,经6~36个月随访,皮瓣质地优良、色泽接近正常,弹性与周围正常皮肤接近,愈合瘢痕较小,外形美观。术后疗效评价:满意8例,一般3例,无不满意病例。肘关节功能评价:优4例,良6例,可1例。皮瓣肿胀评级:早期I度6例,U度3例,皿度2例;后期I度8例,II度2例,皿度1例。结论前臂近端挠侧肘下动脉穿支皮瓣解剖位置恒定、血液供应良好,手术方法简单、安全,是修复肘部皮肤软组织缺损新的补充术式,可供临床选择。Objective To evaluate the design and clinical application of forearm proximal radialinferior cubital artery perforator flap. Methods The clinical data of 11 patients with defects of anteriorelbow from June 2013 to June 2018 were analyzed retrospectively, in which including 8 male and 3 female,mean age is 51.5 years old, ranged from 48 to 76 years old. The sizes of soft tissue defects ranged from7. 5 cmx4. 5 cm to 14 cm x 7 cm. Forearm proximal inferior cubital artery perforator flaps were used torepair the defects according to flap their location, size and shape, in which the largest is 15 cmX 10 cm andthe smallest is 7 cmx5 cm. To evaluate the effect according to flap survival, infection control, elasticity andcolor, appearance, the scar of the donor site, cutaneous sense, and satisfaction of patients. The elbowefficacy and function were evaluated according to Mayo criteria and the swelling degree of flap was also evaluated. Results All the flaps survived in 11 cases, the incisions in donor and recipient site wereprimary healing. The survival of flaps is good and the appearance, color and elasticity are close to normal,on the other hand, the scar at the donor site is small after 6 to 36 months follow-up. The efficacy is satisfiedin 8 cases, general in 3 cases and no dissatisfactory. The function of elbow is excellent in 4 cases, good in6 cases and general in 1 case. Skin swelling rating in early stage is 1st degree in 6 cases, 2nd degree in 3cases, 3rd degree in 2 cases;in later stage is 1st degree in 8 cases, 2nd degree in 2 cases, 3rd degree in1 case. Conclusions The anatomic position of forearm proximal radial inferior cubital artery perforator flapis constant, the blood supply is good, and the operation method is simple and safe which could be a newsupplementary method and be available for clinical selection to repair the soft tissue defects of elbow.

关 键 词：前臂 肘下动脉 外科皮瓣 显微外科技术 疗效评价 

分 类 号：R68[医药卫生—骨科学]