以骨间前血管为受区血管的游离皮瓣修复前臂创面5例  

Free flap transfer in treatment of forearm wounds with anterior interosseous vessels as the recipient vessels:a report of 5 cases

作　　者：周涛[1] 王乾坤 何亮 周定[1] 王子富 黄俊[1] 钟林[1] 牛杨 金哲 尹东 周洪翔[1] ZHOU Tao;WANG Qiankun;HE Liang;ZHOU Ding;WANG Zifu;HUANG Jun;ZHONG Lin;NIU Yang;JIN Zhe;YIN Dong;ZHOU Hongxiang(Department of Orthopaedics,Hand and Foot Reconstruction Ward,the First Affiliated Hospital of Anhui Medical University,Hefei 230031,China)

机构地区：[1]安徽医科大学第一附属医院骨科手足修复重建病区,合肥230031

出　　处：《中华显微外科杂志》2024年第4期404-409,共6页Chinese Journal of Microsurgery

基　　金：安徽省教育厅基金(2022AH0511511)。

摘　　要：目的探讨以骨间前动、静脉为受区血管的游离皮瓣在治疗前臂创面的临床疗效。方法回顾分析2022年7月-2023年11月安徽医科大学第一附属医院骨科手足修复重建病区收治的5例应用吻合骨间前动、静脉的游离皮瓣修复前臂骨和肌腱外露创面患者,均为男性,年龄31~54岁,平均41.8岁,其中前臂中段尺背侧创面2例,前臂远端创面2例,前臂桡掌侧创面1例。清创后组织外露面积11.0 cm×4.5 cm~20.0 cm×6.0 cm,应用游离股前外侧穿支皮瓣(ALTPF)修复前臂创面4例,皮瓣面积13.0 cm×6.0 cm~22.0 cm×7.0 cm,应用游离旋髂浅动脉穿支皮瓣1例,皮瓣面积12.0 cm×5.5 cm,供区均直接缝合。定期门诊随访患者,观察患者皮瓣血运、质地、外观、骨折愈合及患肢功能等,并根据英国医学研究会(BMRC)感觉功能评定标准评定皮瓣感觉。结果5例患者均获随访,随访时间4~16个月,平均8.8个月。皮瓣均完全成活,未出现边缘坏死和伤口感染,皮瓣色泽、质地良好。患肢手部血供良好,未出现发凉、怕冷症状。末次随访根据BMRC感觉功能评定标准评定,皮瓣感觉达S 2~S 3+,外观满意。结论以骨间前动、静脉为受区血管的游离皮瓣治疗前臂创面可获得满意的临床疗效,值得进一步深入研究。ObjectiveTo investigate the clinical effect of free flap transfer with anastomosis of anterior interosseous artery and accompanying veins as the recipient vessels in reconstruction of forearm defects.MethodsA retrospective study was conducted on 5 patients who received free flaps transfers with anastomoses of anterior interosseous artery and accompanying veins in reconstruction of forearm defects with exposed bone and tendon in the Department of Orthopaedics of the First Affiliated Hospital of Anhui Medical University between July 2022 and November 2023.All patients were males,aged 31 to 54 years old with an average age of 41.8 years old.Two patients had defects of dorsal ulnar forearm,2 of distal forearm and 1 of radial palmar forearm.The defected areas after debridement sized 11.0 cm×4.5 cm-20.0 cm×6.0 cm.Free anterolateral thigh perforator flaps(ALTPF),sized 13.0 cm×6.0 cm-22.0 cm×7.0 cm,were used in 4 patients to reconstruct the forearm defects.A free superficial circumflex iliac artery perforator flap was used in 1 patient with the flap sized at 12.0 cm×5.5 cm.All donor sites were directly sutured.Scheduled postoperative follow up was carried out to evaluate the blood supply to the flaps,texture,appearance,fracture healing and the function of the affected limb,as well as the flap sensation according to the criteria for sensory function of British Medical Research Council(BMRC).ResultsAll 5 patients had received 4 to 16(mean 8.8)months of follow-up.All flaps survived completely without necrosis or infection.All flaps were good in colour and texture.The blood supply to hands was good,without a symptoms of coldness and fear of cold of hand.At the final follow-up review,sensation of flaps was assessed according to the criteria for sensory function of BMRC and the sensation of the flaps had recovered to S 2~S 3+.The appearance of flaps was good.ConclusionFree flap with the anterior interosseous artery and accompanying veins as the recipient vessels in the treatment of forearm defects can achieve satisfactory

关 键 词：骨间前动脉 骨间前静脉 外科皮瓣 创面修复 前臂 

分 类 号：R658.2[医药卫生—外科学]