Repair of large skin defect of upper limb with abdominal pedicled flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Ziyang ,  TANG Xiujun , WEI Zairong , JIN Wenhu , WANG Dali , WANG Bo , DENG Chengliang

Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China;

Corresponding author：

TANG Xiujun, Email: xiujunsszx@163.com

Keywords：

Abdominal pedicled flap; perforator flap; improved suture; wound repair; upper limb

DOI：

10.7507/1002-1892.201703099

Video：

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Objective To investigate the feasibility and effectiveness of designing wide pedicle of abdominal pedicled flap and repairing large skin defect of upper limb with improved suture method. Methods Between March 2014 and August 2016, 11 cases with hand and forearm skin soft tissue defect were repaired with abdominal pedicled flaps. Among them, 8 cases were male and 3 were female; aged 18-65 years (mean, 38 years). The causes of injury were machinery injury in 7 cases and traffic accident in 4 cases. The wound located at left upper limb in 6 cases and right upper limb in 5 cases. The size of wound ranged from 12 cm×7 cm to 20 cm×10 cm. The interval from injury to operation was 2-5 days (mean, 4 days). Four cases were repaired with lower abdominal flap and 7 with umbilical flap. The size of flap ranged from 10 cm×9 cm to 22 cm×10 cm. And the flap was designed with wide pedicle at width of 8 to 18 cm (mean, 15 cm); then the wound was sutured with improved method. The pedicle was cut after 3 weeks. Results All the flaps survived without congestion, necrosis, and tension blisters. The wound and the incision were both healed at stage Ⅰ. All patients were followed up 4-12 months (mean, 8 months). The skin color, texture, and shape were satisfying, and no ulcer formed. Only line-like scar left at the donor site. Conclusion Abdominal pedicled flap with wide pedicle and improved suture method can reduce the abdominal skin waste, avoid postoperative infection, and be feasible to repair large skin defect of upper limb with advantages of simple operation and reliable fixation.

Citation： ZHANG Ziyang, TANG Xiujun, WEI Zairong, JIN Wenhu, WANG Dali, WANG Bo, DENG Chengliang. Repair of large skin defect of upper limb with abdominal pedicled flap. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1102-1105. doi: 10.7507/1002-1892.201703099 Copy

1.	韩军涛, 谢松涛, 陶克, 等. 腹部窄蒂轴型皮瓣的设计及临床应用. 中华损伤与修复杂志 (电子版), 2014, 9(4): 58-59.
2.	唐修俊, 魏在荣, 王波, 等. 改良带蒂旋髂浅动脉皮瓣修复手部及前臂创面. 中国修复重建外科杂志, 2012, 26(8): 943-945.
3.	金文虎, 魏在荣, 邓呈亮, 等. 游离旋股外侧动脉降支穿支组织瓣的临床应用及对供区影响观察. 中国修复重建外科杂志, 2015, 29(10): 1284-1287.
4.	庞梦茹, 肖海涛, 王怀胜, 等. 应用不同皮瓣修复手掌重度瘢痕挛缩畸形的临床分析. 中国修复重建外科杂志, 2016, 30(3): 382-384.
5.	张剑锋, 王斌, 王辉, 等. 改良指固有动脉逆行岛状皮瓣与腹部超薄皮瓣修复远节脱套伤的疗效比较. 中国骨与关节损伤杂志, 2015, 30(11): 1178-1180.
6.	孙晓晨, 刘毅, 张绪生, 等. 腹部" 翼型”带蒂皮瓣在手部创伤缺损修复术中的应用. 创伤外科杂志, 2016, 18(2): 117-118.
7.	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.
8.	肖森, 刘光军, 谭琪, 等. 上腹部双叶带蒂瓦合皮瓣修复手或前臂掌背侧皮肤缺损. 中国修复重建外科杂志, 2015, 29(2): 194-197.
9.	刘利华. 复合组织瓣移植修复四肢严重创伤后皮肤缺损的临床研究. 中国美容医学, 2016, 25(9): 11-13.
10.	王进, 王慜, 徐媛, 等. 脐旁穿支皮瓣在手和前臂深度软组织缺损修复中的应用. 组织工程与重建外科杂志, 2016, 12(4): 248-250.
11.	吕宏达, 王根林, 刘跃飞, 等. 三种手部创面移植皮瓣修复效果的评价. 中国组织工程研究, 2015, 19(24): 3929-3936.
12.	蒙家辉, 张文作, 曾业龙, 等. 腹部超薄皮瓣修复手部创面的远期疗效分析. 中华手外科杂志, 2009, 25(5): 290.
13.	Urushidate S, Yotsuyanagi T, Yamauchi M, et al. Modified thin abdominal wall flap (glove flap) for the treatment of acute burns to the hands and fingers. J Plast Reconstr Aesthet Surg, 2010, 63(4): 693-699.
14.	O’Shaughnessy KD, Rawlani V, Hijjawi JB, et al. Oblique pedicled paraumbilical perforator-based flap for reconstruction of complex proximal and mid-forearm defects: a report of two cases. J Hand Surg (Am), 2010, 35(7): 1105-1110.
15.	孙广峰, 聂开瑜, 邓呈亮, 等. 游离旋髂浅动脉穿支皮瓣修复足踝部皮肤软组织缺损. 中国修复重建外科杂志, 2016, 30(11): 1396-1399.
16.	Shukla L, Taylor GI, Shayan R. The pedicled inferior paraumbilical perforator (I-PUP) flap for a volar wrist defect: a reconstructive solution across the ages. J Plast Reconstr Aesthet Surg, 2013, 66(11): 1613-1615.
17.	Krishnamoorthy R, Karthikeyan G. Degloving injuries of the hand. Indian J Plast Surg, 2011, 44(2): 227-236.
18.	Khandelwal S. An Abdominal Flap to Save the Right Forearm and the Hand, Following a High-voltage Electric Burn in a Child: A Case Report. J Clin Diagn Res, 2013, 7(7): 1473-1475.

1. 韩军涛, 谢松涛, 陶克, 等. 腹部窄蒂轴型皮瓣的设计及临床应用. 中华损伤与修复杂志 (电子版), 2014, 9(4): 58-59.
2. 唐修俊, 魏在荣, 王波, 等. 改良带蒂旋髂浅动脉皮瓣修复手部及前臂创面. 中国修复重建外科杂志, 2012, 26(8): 943-945.
3. 金文虎, 魏在荣, 邓呈亮, 等. 游离旋股外侧动脉降支穿支组织瓣的临床应用及对供区影响观察. 中国修复重建外科杂志, 2015, 29(10): 1284-1287.
4. 庞梦茹, 肖海涛, 王怀胜, 等. 应用不同皮瓣修复手掌重度瘢痕挛缩畸形的临床分析. 中国修复重建外科杂志, 2016, 30(3): 382-384.
5. 张剑锋, 王斌, 王辉, 等. 改良指固有动脉逆行岛状皮瓣与腹部超薄皮瓣修复远节脱套伤的疗效比较. 中国骨与关节损伤杂志, 2015, 30(11): 1178-1180.
6. 孙晓晨, 刘毅, 张绪生, 等. 腹部" 翼型”带蒂皮瓣在手部创伤缺损修复术中的应用. 创伤外科杂志, 2016, 18(2): 117-118.
7. 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.
8. 肖森, 刘光军, 谭琪, 等. 上腹部双叶带蒂瓦合皮瓣修复手或前臂掌背侧皮肤缺损. 中国修复重建外科杂志, 2015, 29(2): 194-197.
9. 刘利华. 复合组织瓣移植修复四肢严重创伤后皮肤缺损的临床研究. 中国美容医学, 2016, 25(9): 11-13.
10. 王进, 王慜, 徐媛, 等. 脐旁穿支皮瓣在手和前臂深度软组织缺损修复中的应用. 组织工程与重建外科杂志, 2016, 12(4): 248-250.
11. 吕宏达, 王根林, 刘跃飞, 等. 三种手部创面移植皮瓣修复效果的评价. 中国组织工程研究, 2015, 19(24): 3929-3936.
12. 蒙家辉, 张文作, 曾业龙, 等. 腹部超薄皮瓣修复手部创面的远期疗效分析. 中华手外科杂志, 2009, 25(5): 290.
13. Urushidate S, Yotsuyanagi T, Yamauchi M, et al. Modified thin abdominal wall flap (glove flap) for the treatment of acute burns to the hands and fingers. J Plast Reconstr Aesthet Surg, 2010, 63(4): 693-699.
14. O’Shaughnessy KD, Rawlani V, Hijjawi JB, et al. Oblique pedicled paraumbilical perforator-based flap for reconstruction of complex proximal and mid-forearm defects: a report of two cases. J Hand Surg (Am), 2010, 35(7): 1105-1110.
15. 孙广峰, 聂开瑜, 邓呈亮, 等. 游离旋髂浅动脉穿支皮瓣修复足踝部皮肤软组织缺损. 中国修复重建外科杂志, 2016, 30(11): 1396-1399.
16. Shukla L, Taylor GI, Shayan R. The pedicled inferior paraumbilical perforator (I-PUP) flap for a volar wrist defect: a reconstructive solution across the ages. J Plast Reconstr Aesthet Surg, 2013, 66(11): 1613-1615.
17. Krishnamoorthy R, Karthikeyan G. Degloving injuries of the hand. Indian J Plast Surg, 2011, 44(2): 227-236.
18. Khandelwal S. An Abdominal Flap to Save the Right Forearm and the Hand, Following a High-voltage Electric Burn in a Child: A Case Report. J Clin Diagn Res, 2013, 7(7): 1473-1475.

Chinese Journal of Reparative and Reconstructive Surgery

Repair of large skin defect of upper limb with abdominal pedicled flap

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