CAJ | 학술논문

目的介绍前臂骨间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,由骨间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,由骨间前动脉在前臂近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,由骨间前动脉在前臂中远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.
목적 개소전비골간배역행도상피판적혈관변이류형급처리체회.방법 1990년지2012년아과공개전전비골간배역행도상피판400여례,대기중속우혈관변이적30례진행회고분석,인위혈관변이유이하류형:골간배동맥미산세약무명학종말지,야무명현피지진입피판,유골간배동맥기시발출천지,자피판근측진입14례;골간배동맥미산세약무명학종말지,야무명현피지진입피판,유골간전동맥재전비근1/3뇨측완신기、지총신기간극발출천지8례;골간배동맥결실,유골간전동맥재전비중원1/3교계무장신기、지총신기간극발출조대천지8례.결과 속우혈관변이적전비골간배역행도상피판공30례,술후24례완전순리존활;4례근측피지형피판출현정맥혈류수한,탁제체부봉선후순리존활,2례뇨측피지대상형피판원체단약1/3간성배사,여확창육아생장량호후취전후피편식피수복.20례획득3～6개월적수방,피판외관만의,공구식피유합,미출현골간배신경손상병발증.결론 정학인식전비골간배역행도상피판적혈관변이류형유조우피면수술방기병제고수술적성공솔.
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 antebrachial branch of the posterior interosseous artery carried out in our department from 1990 to 2012 were summarized.Vascular variatiom existed in 30 cases which were retrospectively analyzed.These variations included the following types.Instead of giving off a dominant terminal branch,the posterior interosseous 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 interosseous artery and entered the flaps proximally.This vascular variation occurred in 14 cases.The posterior interosseous 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 comminus in 8 cases.In the third vascular variation the posterior interosseous artery was absent.The anterior imerosseous artery gave off a thick perforator at the junction of middle and distal 1/3 of the forearm level between extensor hallucis longus and extensor digitormn comminus.This variation occurred in 8 cases.Results There were 30 cases that had vascular variation of the posterior intemsseous 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 cases,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 vascular variations of the reverse-flow posterior interosseous artery forearm island flaps can help to avoid surgical abandon and increase the success rate of the surgery.