逆行前臂外侧皮神经营养血管筋膜蒂皮瓣的临床应用
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摘要
目的探讨逆行前臂外侧皮神经营养血管筋膜蒂皮瓣临床应用的效果,评价其临床价值。方法采用逆行前臂外侧皮神经营养血管筋膜蒂皮瓣修复手腕部皮肤软组织缺损12例,切取皮瓣最大面积12 cm×7 cm,最小5 cm×4 cm。结果12例皮瓣完全成活,早期1例出现皮瓣远端小部分坏死,经扩创、二期缝合后创面愈合。经3～48个月随访,皮瓣质地柔软,外观良好。结论逆行前臂外侧皮神经营养血管筋膜蒂皮瓣切取方便,创伤小,只要掌握好适应症,重视蒂部的改良处理,则皮瓣成活率高,是修复手腕部皮肤软组织缺损的最理想选择之一。
Objective To study the clinical effects of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve,evaluate its clinical value. Methods Twelve cases with the skin and soft tissue defects of the hand or the wrist were repaired with the flaps, the sizes of flaps were 12 cm×7 cm to 5 cm×4 cm. Results Twelve flaps were entirely survived, 1 flap had parital necrosis, and obtained healing after debridement. All patients were followed up 3～48 months. The flaps had good texture and appearance. Conclusion With easy procedure, small trauma and high survival rate, it is one of the best way to repair the skin and soft tissue defects in the hands and wrists by retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve.
Objective To study the clinical effects of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve,evaluate its clinical value. Methods Twelve cases with the skin and soft tissue defects of the hand or the wrist were repaired with the flaps, the sizes of flaps were 12 cm×7 cm to 5 cm×4 cm. Results Twelve flaps were entirely survived, 1 flap had parital necrosis, and obtained healing after debridement. All patients were followed up 3～48 months. The flaps had good texture and appearance. Conclusion With easy procedure, small trauma and high survival rate, it is one of the best way to repair the skin and soft tissue defects in the hands and wrists by retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve.
引文
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[2]Masquelet A C,Romma M C,Wolf G.Skin island flaps supplied by the vascular axis of the sensitive superflicial nerves anatomic study and clinical experience in the leg[J].Plast Reconstr Surg,1992,89(6):1115-1119.PMID:1584872
[3]Pauchot J,Assouline U,Valmary-Degano S,et al.Transfer of the lateral antebrachial cutaneous nerve to the dorsal branch of the ulnar nerve without nerve graft in case of lower brachial plexus injuries:anatomical and feasibility study[J].Hand Surg Rehabil,2017,36(4):296-300.PMID:28623105DOI:10.1016/j.hansur.2017.05.003
[4]Im HS,Im JY,Kim KH,et al.Ultrasonographic Study of the anatomical relationship between the lateral antebrachial cutaneous nerve and the cephalic vein[J].Ann Rehabil Med,2017,41(3):421-425.PMID:28758079 PMCID:PMC5532347 DOI:10.5535/arm.2017.41.3.421
[5]Yung H,Lagemann G M,Lin A,et al.Lateral antebrachial cutaneous nerve entrapment after shoulder arthroscopy:a case report[J].PM R,2015,7(8):889-894.PMID:25772722 DOI:10.1016/j.pmrj.2015.03.009
[6]Taylor G I,Gianoutsos M P,Morris S F.The neurovascular territories of the skin and muscles:anatomic study and clinical implications[J].Plast Reconstr Surg,1994,94(1):1-5.PMID:8016221
[7]芮永军,徐建光,顾玉东.以上肢和手部浅表皮神经营养血管为蒂皮瓣的解剖学[J].中华手外科杂志,1997,13(4):226-230.
[8]钟世镇,徐永清,周长满,等.皮神经营养血管皮瓣解剖基础及命名[J].中华显微外科杂志,1999,22(1):37-39.DOI:10.3760/cma.j.issn.1001-2036.1999.01.014
[9]甘干达,陶智刚,胡建方,等.带前臂外侧皮神经营养皮瓣修复手背部软组织缺损[J].创伤外科杂志,2006,8(5):405-407.DOI:10.3969/j.issn.1009-4237.2006.05.007
[10]罗少军,王绥江,汤少明,等.前臂外侧皮神经营养血管远端蒂筋膜皮瓣的解剖和临床应用[J].中华显微外科杂志,1999,22(4):283-284.
[11]谢艾玲,张荐,卢爱东,等.逆行前臂外侧皮神经营养血管筋膜蒂皮瓣修复手部皮肤缺损[J].中国修复重建外科杂志,2014,28(12):1498-1500.DOI:10.7507/1002-1892.20140324
[2]Masquelet A C,Romma M C,Wolf G.Skin island flaps supplied by the vascular axis of the sensitive superflicial nerves anatomic study and clinical experience in the leg[J].Plast Reconstr Surg,1992,89(6):1115-1119.PMID:1584872
[3]Pauchot J,Assouline U,Valmary-Degano S,et al.Transfer of the lateral antebrachial cutaneous nerve to the dorsal branch of the ulnar nerve without nerve graft in case of lower brachial plexus injuries:anatomical and feasibility study[J].Hand Surg Rehabil,2017,36(4):296-300.PMID:28623105DOI:10.1016/j.hansur.2017.05.003
[4]Im HS,Im JY,Kim KH,et al.Ultrasonographic Study of the anatomical relationship between the lateral antebrachial cutaneous nerve and the cephalic vein[J].Ann Rehabil Med,2017,41(3):421-425.PMID:28758079 PMCID:PMC5532347 DOI:10.5535/arm.2017.41.3.421
[5]Yung H,Lagemann G M,Lin A,et al.Lateral antebrachial cutaneous nerve entrapment after shoulder arthroscopy:a case report[J].PM R,2015,7(8):889-894.PMID:25772722 DOI:10.1016/j.pmrj.2015.03.009
[6]Taylor G I,Gianoutsos M P,Morris S F.The neurovascular territories of the skin and muscles:anatomic study and clinical implications[J].Plast Reconstr Surg,1994,94(1):1-5.PMID:8016221
[7]芮永军,徐建光,顾玉东.以上肢和手部浅表皮神经营养血管为蒂皮瓣的解剖学[J].中华手外科杂志,1997,13(4):226-230.
[8]钟世镇,徐永清,周长满,等.皮神经营养血管皮瓣解剖基础及命名[J].中华显微外科杂志,1999,22(1):37-39.DOI:10.3760/cma.j.issn.1001-2036.1999.01.014
[9]甘干达,陶智刚,胡建方,等.带前臂外侧皮神经营养皮瓣修复手背部软组织缺损[J].创伤外科杂志,2006,8(5):405-407.DOI:10.3969/j.issn.1009-4237.2006.05.007
[10]罗少军,王绥江,汤少明,等.前臂外侧皮神经营养血管远端蒂筋膜皮瓣的解剖和临床应用[J].中华显微外科杂志,1999,22(4):283-284.
[11]谢艾玲,张荐,卢爱东,等.逆行前臂外侧皮神经营养血管筋膜蒂皮瓣修复手部皮肤缺损[J].中国修复重建外科杂志,2014,28(12):1498-1500.DOI:10.7507/1002-1892.20140324