REPAIR OF UPPER LIMBS TISSUE DEFECT WITH DISSOCIATIVE SAPHENOUS ARTERIA FLAP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YANGHuanyou ¹ , ZHANGJian ¹ , ZHOUHongguang ² , HUOYongxin ¹ , LIUWei ¹ , ZHANGJianfeng ¹

1. The 1st Department of Hand Surgery, Department of Reparative and Reconstructive Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China;
2. Department of Orthopedics, Caofeidian District Hospital of Tangshan;

Corresponding?author：

YANGHuanyou, Email: yanghuanyou123@126.com

Keywords：

Dissociative saphenous arteria flap; Saphenous artery; Upper limb; Wound repair

DOI：

10.7507/1002-1892.20150127

Video：

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Objective To explore the effectiveness of the dissociative saphenous arteria flap in repairing upper limbs soft tissue defect. Methods Between June 2012 and April 2014, 10 cases of skin and soft tissue defects at the upper limbs were treated, including 6 males and 4 females with an average age of 42 years (range, 23-58 years). The causes of injury was the machine injury in 9 cases, the interval of injury and operation was 2 hours to 32 days (mean, 5.5 days); the locations were the dorsal radial side in 3 cases and the dorsal forearm in 6 cases. Skin defect with tendon exposure was observed in 1 case after contracture of the first web space resection. The defect size varied from 5 cm×3 cm to 16 cm×9 cm. The size of the flaps ranged from 6.0 cm×3.6 cm to 19.2 cm×10.8 cm. In 7 cases, the saphenous nerve was anastomosed with the nerve of the donor (cutaneous nerve, radial nerve, or ulnar nerve); in 5 cases, tendon defect was repaired by sartorius muscle tendon bridge. The donor sites were repaired by free skin graft or suture. Results The other flaps survived and obtained healing by first intention except 1 flap which had partial necrosis with healing by second intention. The skin graft at donor site survived. All patients were followed up 5-17 months (mean, 12 months). The flaps had good color and texture without contracture. At last follow-up, the sensation recovered to S₁-S_3⁺; in 7 cases undergoing nerve anastomosis, the sensation reached S₃-S_3⁺, and it was better than that not undergoing nerve anastomosis (S₁-S₂); in 5 cases receiving sartorius muscle tendon bridging, the hand function recovered satisfactorily except 1 case of total active movement (TAM) value >75% of contralateral TAM at last follow-up. According to the Chinese Medical Society of Hand Surgery function evaluation standards, the results were excellent in 8 cases and good in 2 cases. Conclusion The dissociative saphenous arteria flap is an effective way to repair skin defects of the upper limbs because of reliable blood supply and simple surgical procedure.

Citation： YANGHuanyou, ZHANGJian, ZHOUHongguang, HUOYongxin, LIUWei, ZHANGJianfeng. REPAIR OF UPPER LIMBS TISSUE DEFECT WITH DISSOCIATIVE SAPHENOUS ARTERIA FLAP. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(5): 586-589. doi: 10.7507/1002-1892.20150127 Copy

1.	林澗, 余云蘭, 范啟申, 等. 手部皮膚逆行撕脫傷的修復. 中華創傷雜志, 2004, 20(7):442-443.
2.	侯春林. 帶血管蒂組織瓣移位手術圖解. 上海:上海科學技術出版社, 2006:177-180.
3.	盛志勇, 郭恩覃, 魯開化. 整形與燒傷外科手術學. 2版. 北京:人民軍醫出版社, 2004:133-134.
4.	陳宏, 竺楓, 薛建波, 等. 游離膝降動脈穿支皮瓣的臨床研究. 中華手外科雜志, 2011, 27(3):156-158.
5.	潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3):130-135.
6.	何尚寬, 黃位耀, 鐘桂午. 帶隱血管蒂骨膜骨瓣轉位修復股骨缺損骨不連的應用解剖. 中國臨床解剖學雜志, 1999, 12(1):11-13.
7.	黃長征, 范偉杰, 廖瑛, 等. 膝內側游離皮瓣修復足跟軟組織缺損的研究與應用. 現代生物醫學進展, 2010, 10(8):1511-1512.
8.	黎文, 林志雄, 白波, 等. 脛骨開放性骨折的治療. 中華創傷雜志, 2005, 21(2):91-93.
9.	李志杰, 高偉陽, 陳星隆, 等. 負壓引流結合皮瓣修復治療難治性感染缺損創面. 中華顯微外科雜志, 2010, 33(2):150-151.
10.	任高宏, 黎潤光, 劉勇, 等. 應用封閉式負壓引流及游離皮瓣治療小兒肢體大面積軟組織缺損. 中華顯微外科雜志, 2010, 33(5):363-367.
11.	竇勃, 王江泳, 張英澤, 等. 雷公藤甲素對同種異體肌腱移植修復雞肌腱缺損的作用. 中國修復重建外科雜志, 2012, 26(7):869-873.
12.	唐恒濤, 王闖建, 嚴旭, 等. 同種異體肌腱移植修復跟腱斷裂. 中國組織工程研究, 2013, 17(31):5626-5632.
13.	孫燕琨, 張友樂, 李祥, 等. 異體肌腱移植術后粘連原因分析. 中國修復重建外科雜志, 2008, 22(3):346-348.
14.	王震寰, 秦登友. 隱神經卡壓征的臨床解剖學研究. 中國矯形外科雜志, 2002, 9(7):699-701.
15.	高峻青, 陳遜文, 陳浩宇, 等. 肢體復合組織缺損皮瓣修復異體肌腱移植功能重建療效分析. 中國修復重建外科雜志, 2009, 23(1):64-67.
16.	Iorio ML, Masden DL, Higgins JP. The limits of medial femoral condyle corticoperiosteal flaps. J Hand Surg (Am), 2011, 36(10):1592-1596.
17.	劉漢前, 俞輝明, 劉家武. 頦下島狀皮瓣修復早期口腔鱗狀細胞癌術后缺損.中國修復重建外科雜志, 2013, 27(9):1098-1101.
18.	于鐵強, 左玉明, 王月光, 等. 封閉式負壓引流技術聯合腓腸神經營養血管皮瓣修復兒童足跟部軟組織缺損. 中國修復重建外科雜志, 2013, 27(5):637-638.

1. 林澗, 余云蘭, 范啟申, 等. 手部皮膚逆行撕脫傷的修復. 中華創傷雜志, 2004, 20(7):442-443.
2. 侯春林. 帶血管蒂組織瓣移位手術圖解. 上海:上海科學技術出版社, 2006:177-180.
3. 盛志勇, 郭恩覃, 魯開化. 整形與燒傷外科手術學. 2版. 北京:人民軍醫出版社, 2004:133-134.
4. 陳宏, 竺楓, 薛建波, 等. 游離膝降動脈穿支皮瓣的臨床研究. 中華手外科雜志, 2011, 27(3):156-158.
5. 潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3):130-135.
6. 何尚寬, 黃位耀, 鐘桂午. 帶隱血管蒂骨膜骨瓣轉位修復股骨缺損骨不連的應用解剖. 中國臨床解剖學雜志, 1999, 12(1):11-13.
7. 黃長征, 范偉杰, 廖瑛, 等. 膝內側游離皮瓣修復足跟軟組織缺損的研究與應用. 現代生物醫學進展, 2010, 10(8):1511-1512.
8. 黎文, 林志雄, 白波, 等. 脛骨開放性骨折的治療. 中華創傷雜志, 2005, 21(2):91-93.
9. 李志杰, 高偉陽, 陳星隆, 等. 負壓引流結合皮瓣修復治療難治性感染缺損創面. 中華顯微外科雜志, 2010, 33(2):150-151.
10. 任高宏, 黎潤光, 劉勇, 等. 應用封閉式負壓引流及游離皮瓣治療小兒肢體大面積軟組織缺損. 中華顯微外科雜志, 2010, 33(5):363-367.
11. 竇勃, 王江泳, 張英澤, 等. 雷公藤甲素對同種異體肌腱移植修復雞肌腱缺損的作用. 中國修復重建外科雜志, 2012, 26(7):869-873.
12. 唐恒濤, 王闖建, 嚴旭, 等. 同種異體肌腱移植修復跟腱斷裂. 中國組織工程研究, 2013, 17(31):5626-5632.
13. 孫燕琨, 張友樂, 李祥, 等. 異體肌腱移植術后粘連原因分析. 中國修復重建外科雜志, 2008, 22(3):346-348.
14. 王震寰, 秦登友. 隱神經卡壓征的臨床解剖學研究. 中國矯形外科雜志, 2002, 9(7):699-701.
15. 高峻青, 陳遜文, 陳浩宇, 等. 肢體復合組織缺損皮瓣修復異體肌腱移植功能重建療效分析. 中國修復重建外科雜志, 2009, 23(1):64-67.
16. Iorio ML, Masden DL, Higgins JP. The limits of medial femoral condyle corticoperiosteal flaps. J Hand Surg (Am), 2011, 36(10):1592-1596.
17. 劉漢前, 俞輝明, 劉家武. 頦下島狀皮瓣修復早期口腔鱗狀細胞癌術后缺損.中國修復重建外科雜志, 2013, 27(9):1098-1101.
18. 于鐵強, 左玉明, 王月光, 等. 封閉式負壓引流技術聯合腓腸神經營養血管皮瓣修復兒童足跟部軟組織缺損. 中國修復重建外科雜志, 2013, 27(5):637-638.

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Chinese Journal of Reparative and Reconstructive Surgery

REPAIR OF UPPER LIMBS TISSUE DEFECT WITH DISSOCIATIVE SAPHENOUS ARTERIA FLAP

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