REPAIRING SKIN AND SOFT TISSUE DEFECT IN PALM OR DORSUM OF HAND AND FOREARM WITH EPIGASTRIC BILOBED FLAP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIAOSen ¹ ,  LIUGuangjun ² , TANQi ² , WANGQian ² , WANGChengqi ²

1. Graduate School, Weifang Medical University, Weifang Shandong, 261021, P. R. China;
2. the Third Department of Traumatology Center, the 89 th Hospital of Chinese PLA;

Corresponding?author：

LIUGuangjun, Email: xiaodasen@163.com

Keywords：

Forearm; Skin and soft tissue defect; Epigastric bilobed flap

DOI：

10.7507/1002-1892.20150042

Video：

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Objective To introduce the surgical method and effectiveness of repairing skin and soft tissue defect in the palm or dorsum of the hand and forearm with epigastric bilobed flap. Methods Between October 2010 and December 2013, 4 male patients with skin and soft tissue defect in the palm or dorsum of the hand and forearm were treated, aged from 36 to 62 years. Of them, 3 cases had degloving injury caused by machines and 1 case had necrosis of fingers and skin after surgery of crush injury. The time from injury to hospitalization was from 3 hours to 15 days. Among the 4 cases, the size of palmar defect was 7 cm×4 cm to 16 cm×6 cm, and the size of dorsal defect was 10 cm×7 cm to 20 cm×10 cm. The epigastric bilobed flap was designed based on the axial vessel which was formed by inferior epigastric artery, superior epigastric artery, and intercostals arteries. The size of flap ranged from 12 cm×4 cm to 18 cm×6 cm in the vertical direction, 15 cm×8 cm to 22 cm×11 cm in the oblique direction. The donor site was directly closed. The pedicles were cut at 22 to 24 days after repairing operation. Results All the flaps survived well with the wound healing by first intention. Four patients were followed up 3 months to 1 year and 2 months. The other flaps had good appearance and texture except 1 bulky flap. The flap sensation basically restored to S₂-S₃. The function of the hands recovered well. Conclusion Skin and soft tissue defect in the palm or dorsum of the hand and forearm can be repaired with the epigastric bilobed flap, because it has such advantages as big dermatomic area and adequate blood supply. Besides, the operation is practical, safe, and simple.

Citation： XIAOSen, LIUGuangjun, TANQi, WANGQian, WANGChengqi. REPAIRING SKIN AND SOFT TISSUE DEFECT IN PALM OR DORSUM OF HAND AND FOREARM WITH EPIGASTRIC BILOBED FLAP. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(2): 194-197. doi: 10.7507/1002-1892.20150042 Copy

1.	Murakami M, Hyakusoku H. Reconstruction of a defect after harvesting a radial forearm flap using a narrow pedicled paraumbilical perforator-based subdermal vascular network (super-thin) flap. Scand J Plast Reconstr Surg Hand Surg, 2004, 38(5):281-283.
2.	劉育鳳, 歸來, 張智勇, 等. 主干蒂與穿支蒂穿支皮瓣血流動力學的比較研究. 中國修復重建外科雜志, 2007, 21(4):331-335.
3.	劉元波, 徐軍, 王靜, 等. 應用腹壁下動脈穿支皮瓣再造乳房. 中國修復重建外科雜志, 2006, 20(5):534-536.
4.	周丕育, 楊孝明, 周健, 等. 背闊肌及胸臍皮瓣修復上肢皮膚軟組織缺損. 中華整形外科雜志, 2010, 26(6):459-460.
5.	張兆祥, 郭樹忠, 耿健, 等. 腹壁下動脈穿支皮瓣游離移植修復下肢大面積缺損. 中華顯微外科雜志, 2013, 36(1):15-18.
6.	周曉, 芮永軍, 許亞軍, 等. 腹部對合式真皮下血管網皮瓣修復多指套狀撕脫傷. 中華整形外科雜志, 2012, 28(3):224-225.
7.	潘勇衛, 田光磊. 帶蒂皮瓣移植修復手部創面. 中華手外科雜志, 2006, 22(5):263-266.
8.	周曉, 許亞軍, 芮永軍, 等. 雙蒂腹部真皮下血管網皮管修復2~5指雙指脫套傷. 中國修復重建外科雜志, 2008, 22(11):1402-1403.
9.	官士兵, 孫文海, 李淑媛, 等. 髂腹股溝皮瓣聯合股部皮瓣帶蒂瓦合移植在手部大面積套脫傷治療中的應用. 中華手外科雜志, 2009, 25(2):81-83.
10.	莊躍宏, 黃美賢, 徐達傳. 腹部區穿支體形態學及其血供分區. 中國臨床解剖學雜志, 2012, 30(6):599-604.
11.	邵玉國, 周曉云, 胡修全, 等. 下腹部腹直肌肌皮瓣血供的應用解剖. 中國修復重建外科雜志, 2006, 20(9):877-880.
12.	崔懷瑞, 吳東方, 唐茂林, 等. 腹壁下動脈穿支皮瓣的應用解剖學研究. 中國臨床解剖學雜志, 2011, 29(6):614-618.
13.	Nasir S, Aydin MA. Upper extremity reconstruction using free SCIA/SIEA flap. Microsurgery, 2010, 30 (1):37-42.
14.	Bianchi B, Ferri A, Ferrari S. Superficial inferior epigastric artery adiposal flap for facial contour reconstruction:report of two cases. Journal of Cranio-Maxillofacial Surgery, 2009, 37(5):249-252.
15.	曾昂, 喬群, 方柏榮, 等. 增強CT輔助設計帶蒂腹壁下動脈穿支皮瓣的臨床應用. 中國修復重建外科雜志, 2008, 22(12):1426-1428.
16.	唐茂林, 章偉文, 張世民, 等. 穿支皮瓣研究進展. 中國臨床解剖學雜志, 2011, 29(6):602-605.
17.	孫占勝, 穆衛東, 王魯博, 等. 胸臍雙動脈蒂超薄皮瓣修復手及手指近端軟組織缺損. 中國修復重建外科雜志, 2004, 18(6):454-456.
18.	譚琪, 劉光軍, 楊磊, 等. 腹部穿支瓦合皮瓣修復手部大面積皮膚套脫傷. 中華手外科雜志, 2014, 30(5):341-344.
19.	歐迪軍, 林陽. 應用修薄的腹部穿支皮瓣修復手部皮膚軟組織缺損. 中華顯微外科雜志, 2013, 36(3):300-302.

1. Murakami M, Hyakusoku H. Reconstruction of a defect after harvesting a radial forearm flap using a narrow pedicled paraumbilical perforator-based subdermal vascular network (super-thin) flap. Scand J Plast Reconstr Surg Hand Surg, 2004, 38(5):281-283.
2. 劉育鳳, 歸來, 張智勇, 等. 主干蒂與穿支蒂穿支皮瓣血流動力學的比較研究. 中國修復重建外科雜志, 2007, 21(4):331-335.
3. 劉元波, 徐軍, 王靜, 等. 應用腹壁下動脈穿支皮瓣再造乳房. 中國修復重建外科雜志, 2006, 20(5):534-536.
4. 周丕育, 楊孝明, 周健, 等. 背闊肌及胸臍皮瓣修復上肢皮膚軟組織缺損. 中華整形外科雜志, 2010, 26(6):459-460.
5. 張兆祥, 郭樹忠, 耿健, 等. 腹壁下動脈穿支皮瓣游離移植修復下肢大面積缺損. 中華顯微外科雜志, 2013, 36(1):15-18.
6. 周曉, 芮永軍, 許亞軍, 等. 腹部對合式真皮下血管網皮瓣修復多指套狀撕脫傷. 中華整形外科雜志, 2012, 28(3):224-225.
7. 潘勇衛, 田光磊. 帶蒂皮瓣移植修復手部創面. 中華手外科雜志, 2006, 22(5):263-266.
8. 周曉, 許亞軍, 芮永軍, 等. 雙蒂腹部真皮下血管網皮管修復2~5指雙指脫套傷. 中國修復重建外科雜志, 2008, 22(11):1402-1403.
9. 官士兵, 孫文海, 李淑媛, 等. 髂腹股溝皮瓣聯合股部皮瓣帶蒂瓦合移植在手部大面積套脫傷治療中的應用. 中華手外科雜志, 2009, 25(2):81-83.
10. 莊躍宏, 黃美賢, 徐達傳. 腹部區穿支體形態學及其血供分區. 中國臨床解剖學雜志, 2012, 30(6):599-604.
11. 邵玉國, 周曉云, 胡修全, 等. 下腹部腹直肌肌皮瓣血供的應用解剖. 中國修復重建外科雜志, 2006, 20(9):877-880.
12. 崔懷瑞, 吳東方, 唐茂林, 等. 腹壁下動脈穿支皮瓣的應用解剖學研究. 中國臨床解剖學雜志, 2011, 29(6):614-618.
13. Nasir S, Aydin MA. Upper extremity reconstruction using free SCIA/SIEA flap. Microsurgery, 2010, 30 (1):37-42.
14. Bianchi B, Ferri A, Ferrari S. Superficial inferior epigastric artery adiposal flap for facial contour reconstruction:report of two cases. Journal of Cranio-Maxillofacial Surgery, 2009, 37(5):249-252.
15. 曾昂, 喬群, 方柏榮, 等. 增強CT輔助設計帶蒂腹壁下動脈穿支皮瓣的臨床應用. 中國修復重建外科雜志, 2008, 22(12):1426-1428.
16. 唐茂林, 章偉文, 張世民, 等. 穿支皮瓣研究進展. 中國臨床解剖學雜志, 2011, 29(6):602-605.
17. 孫占勝, 穆衛東, 王魯博, 等. 胸臍雙動脈蒂超薄皮瓣修復手及手指近端軟組織缺損. 中國修復重建外科雜志, 2004, 18(6):454-456.
18. 譚琪, 劉光軍, 楊磊, 等. 腹部穿支瓦合皮瓣修復手部大面積皮膚套脫傷. 中華手外科雜志, 2014, 30(5):341-344.
19. 歐迪軍, 林陽. 應用修薄的腹部穿支皮瓣修復手部皮膚軟組織缺損. 中華顯微外科雜志, 2013, 36(3):300-302.

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Chinese Journal of Reparative and Reconstructive Surgery

REPAIRING SKIN AND SOFT TISSUE DEFECT IN PALM OR DORSUM OF HAND AND FOREARM WITH EPIGASTRIC BILOBED FLAP

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