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.	刘育凤, 归来, 张智勇, 等. 主干蒂与穿支蒂穿支皮瓣血流动力学的比较研究. 中国修复重建外科杂志, 2007, 21(4):331-335.
3.	刘元波, 徐军, 王静, 等. 应用腹壁下动脉穿支皮瓣再造乳房. 中国修复重建外科杂志, 2006, 20(5):534-536.
4.	周丕育, 杨孝明, 周健, 等. 背阔肌及胸脐皮瓣修复上肢皮肤软组织缺损. 中华整形外科杂志, 2010, 26(6):459-460.
5.	张兆祥, 郭树忠, 耿健, 等. 腹壁下动脉穿支皮瓣游离移植修复下肢大面积缺损. 中华显微外科杂志, 2013, 36(1):15-18.
6.	周晓, 芮永军, 许亚军, 等. 腹部对合式真皮下血管网皮瓣修复多指套状撕脱伤. 中华整形外科杂志, 2012, 28(3):224-225.
7.	潘勇卫, 田光磊. 带蒂皮瓣移植修复手部创面. 中华手外科杂志, 2006, 22(5):263-266.
8.	周晓, 许亚军, 芮永军, 等. 双蒂腹部真皮下血管网皮管修复2~5指双指脱套伤. 中国修复重建外科杂志, 2008, 22(11):1402-1403.
9.	官士兵, 孙文海, 李淑媛, 等. 髂腹股沟皮瓣联合股部皮瓣带蒂瓦合移植在手部大面积套脱伤治疗中的应用. 中华手外科杂志, 2009, 25(2):81-83.
10.	庄跃宏, 黄美贤, 徐达传. 腹部区穿支体形态学及其血供分区. 中国临床解剖学杂志, 2012, 30(6):599-604.
11.	邵玉国, 周晓云, 胡修全, 等. 下腹部腹直肌肌皮瓣血供的应用解剖. 中国修复重建外科杂志, 2006, 20(9):877-880.
12.	崔怀瑞, 吴东方, 唐茂林, 等. 腹壁下动脉穿支皮瓣的应用解剖学研究. 中国临床解剖学杂志, 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, 乔群, 方柏荣, 等. 增强CT辅助设计带蒂腹壁下动脉穿支皮瓣的临床应用. 中国修复重建外科杂志, 2008, 22(12):1426-1428.
16.	唐茂林, 章伟文, 张世民, 等. 穿支皮瓣研究进展. 中国临床解剖学杂志, 2011, 29(6):602-605.
17.	孙占胜, 穆卫东, 王鲁博, 等. 胸脐双动脉蒂超薄皮瓣修复手及手指近端软组织缺损. 中国修复重建外科杂志, 2004, 18(6):454-456.
18.	谭琪, 刘光军, 杨磊, 等. 腹部穿支瓦合皮瓣修复手部大面积皮肤套脱伤. 中华手外科杂志, 2014, 30(5):341-344.
19.	欧迪军, 林阳. 应用修薄的腹部穿支皮瓣修复手部皮肤软组织缺损. 中华显微外科杂志, 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. 刘育凤, 归来, 张智勇, 等. 主干蒂与穿支蒂穿支皮瓣血流动力学的比较研究. 中国修复重建外科杂志, 2007, 21(4):331-335.
3. 刘元波, 徐军, 王静, 等. 应用腹壁下动脉穿支皮瓣再造乳房. 中国修复重建外科杂志, 2006, 20(5):534-536.
4. 周丕育, 杨孝明, 周健, 等. 背阔肌及胸脐皮瓣修复上肢皮肤软组织缺损. 中华整形外科杂志, 2010, 26(6):459-460.
5. 张兆祥, 郭树忠, 耿健, 等. 腹壁下动脉穿支皮瓣游离移植修复下肢大面积缺损. 中华显微外科杂志, 2013, 36(1):15-18.
6. 周晓, 芮永军, 许亚军, 等. 腹部对合式真皮下血管网皮瓣修复多指套状撕脱伤. 中华整形外科杂志, 2012, 28(3):224-225.
7. 潘勇卫, 田光磊. 带蒂皮瓣移植修复手部创面. 中华手外科杂志, 2006, 22(5):263-266.
8. 周晓, 许亚军, 芮永军, 等. 双蒂腹部真皮下血管网皮管修复2~5指双指脱套伤. 中国修复重建外科杂志, 2008, 22(11):1402-1403.
9. 官士兵, 孙文海, 李淑媛, 等. 髂腹股沟皮瓣联合股部皮瓣带蒂瓦合移植在手部大面积套脱伤治疗中的应用. 中华手外科杂志, 2009, 25(2):81-83.
10. 庄跃宏, 黄美贤, 徐达传. 腹部区穿支体形态学及其血供分区. 中国临床解剖学杂志, 2012, 30(6):599-604.
11. 邵玉国, 周晓云, 胡修全, 等. 下腹部腹直肌肌皮瓣血供的应用解剖. 中国修复重建外科杂志, 2006, 20(9):877-880.
12. 崔怀瑞, 吴东方, 唐茂林, 等. 腹壁下动脉穿支皮瓣的应用解剖学研究. 中国临床解剖学杂志, 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, 乔群, 方柏荣, 等. 增强CT辅助设计带蒂腹壁下动脉穿支皮瓣的临床应用. 中国修复重建外科杂志, 2008, 22(12):1426-1428.
16. 唐茂林, 章伟文, 张世民, 等. 穿支皮瓣研究进展. 中国临床解剖学杂志, 2011, 29(6):602-605.
17. 孙占胜, 穆卫东, 王鲁博, 等. 胸脐双动脉蒂超薄皮瓣修复手及手指近端软组织缺损. 中国修复重建外科杂志, 2004, 18(6):454-456.
18. 谭琪, 刘光军, 杨磊, 等. 腹部穿支瓦合皮瓣修复手部大面积皮肤套脱伤. 中华手外科杂志, 2014, 30(5):341-344.
19. 欧迪军, 林阳. 应用修薄的腹部穿支皮瓣修复手部皮肤软组织缺损. 中华显微外科杂志, 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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