Objective To investigate an operative method of repairing large skin defect of the forearm and the hand. Methods From July 2003 to September 2008, 11 patients with large skin defect of the forearm and the hand were repaired using bilateral groin flaps in complex with abdominal flaps, including 7 males and 4 females aged 17-55 years old (average33.5 years old). Among the 11 cases, 5 were caused by carding machine and 4 by traffic accident, and the interval between injury and operation was 90 minutes to 6 hours (average 3.5 hours); 2 cases suffered from severe cicatricial contracture deformity in the late stage of burn injury, and the interval between injury and operation was 7 months and 19 months, respectively. The size of skin defect ranged from 42 cm × 12 cm to 60 cm × 16 cm. The flaps harvested during operation was 45.0 cm × 10.5 cm - 62.0 cm × 18.0 cm in size. Pedicle division of the combined flaps was performed 4 weeks after operation. The donor site wound was repaired by direct suturing in 7 cases and by free skin grafting in 4 cases. Results All flaps survived. All incisions healed by first intention. The donor site wound all healed by first intention. Skin graft all survived. All patients were followed up for 2 months to 3 years. The flaps were soft in texture, full in contour, and normal in color. Sensory recovery of the flaps was evaluated according to the Criteria of UK Medical Research Council (1954), 4 cases were in grade S1, 6 in grade S2, and 1 in grade S3. Hand function was assessed by the Criteria of Chinese Hand Surgery Society, 7 cases were graded as excellent, 2 as good, 2 as poor, and the excellent and good rate was 81.8%. Conclusion Combined use of bilateral groin flaps and abdominal flap is an effective approach to repair large skin defect of the forearm and the hand due to its simple operative procedure and satisfying effect.
In order to resolve the shortcomings of traditional pedicled abdominal skin flap, the pedicled abdominal subcorium vascular-net flap was reformed and applied clinically. Twenty-eight cases with scar on hand or wrist were treated, including 20 males and 8 females. The age was ranged from 18 to 35 years old. The key point in the design was rotating 45 degrees of the flap from the primary site toward the pedicle. The ratio of the length to width of the flap was 1-1.8 : 1, and the wound of the donor site was covered by direct suture. Five to seven days later, all the flaps were divided and survived. The advantages of this flap were as follows: skin-grafting on the donor site was not necessary; the time needed for cutting the pedicle was shortened, and the flap is thinner than the traditional flap.
【摘要】 目的 探讨大面积手部皮肤脱套伤并缺损的修复方式。 方法 2005年6月－2010年1月，应用腹部皮瓣包埋和游离中厚皮片植皮结合负压封闭引流（vacuum sealing drainage，VSD）技术治疗手部大面积皮肤脱套伤合并缺损12例，其中男8例，女4例；年龄21~56岁，平均34岁。机器绞伤9例，车祸伤3例。所有损伤均合并肌腱、关节或骨质外露；软组织缺损范围为9 cm×8 cm~25 cm×18 cm。受伤至手术时间4~17 h，平均6.5 h。手掌及手指缺损部位采用腹部带蒂皮瓣包埋；手掌及手指以外肌肉、筋膜完好的部位采用大腿游离中厚皮片植皮，再于植皮表面覆盖VSD敷料，接负压行持续吸引；所有患者均二期断蒂并进行分指或皮瓣成形手术。 结果 术后2例手指部分皮瓣或植皮坏死，2例小部分皮瓣及植皮边缘坏死，经单纯换药后逐渐愈合，1例缺损较大、较深，先行换药，待创面肉芽新鲜后行二期植皮手术，愈合良好 。其余皮瓣及植皮均成活，创面Ⅰ期愈合；供区植皮均成活，切口均Ⅰ期愈合。12例均获6~42个月随访，2例手指末节软组织缺损严重、血运差，术后7~10 d末节坏死后短缩；3例掌侧皮瓣移植后较臃肿；其余外观均较满意。所有患者创面愈合后1个月内深、浅感觉功能均稍差，3~6个月逐渐恢复，但手指精细感觉恢复差，两点辨别觉为6~13 mm，平均9.5 mm。所有患手平均掌指关节主动活动50°，指间关节20°。 结论 腹部皮瓣包埋和游离中厚皮片植皮结合VSD技术能较好地修复手部大面积皮肤脱套伤并缺损，是一种实用、安全且简便的手术方法。【Abstract】 Objective To investigate the ideal repair method for large-area hand avulsed wound and soft tissue defects. Methods From June 2005 to January 2010, 12 patients with large-area hand avulsed wound and soft tissue defects were repaired with abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique. The patients included 8 males and 4 females with their age ranged from 21 to 56 years averaging at 34 years. The causes of injury were machine twist injury in 9 cases and road accident injury in 3 cases. All the injuries combined with exposure of tendon, joint or bone. The area of defects ranged from 8 cm×9 cm to 18 cm×25 cm. The time between injury and operation was 4 to 17 hours averaging at 6.5 hours. The palm of hand and fingers were repaired by abdominal pedicle skin flaps, and the dorsum of hand and wrist were repaired by skin grafting combined with vacuum sealing drainage. About 3 weeks later, all pedicles of the abdominal flaps were cut off and flaps plasty were carried out. Results All patients were followed up from 6 to 42 months with an average period of 17 months. All of the flaps and skin grafts survived. Only 6 patients had distal edge partial necrosis, and all of them healed after a short time of dressing changes or second-stage skin grafting. All skin grafts of the donor sites survived and all the wounds healed by first intention. All the injured hands recovered well to their original shape and function except partial bad skin sensation. The sense of two-point discrimination was from 6 mm to 13 mm with an average distance of 9.5 mm. The active motion of metacarpophalangeal joints averaged at 60°, and the interphalangeal articulations averaged at 30°. Conclusion Abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique can be used to repair large-area hand avulsed wound and soft tissue defects, and it is practical, safe and simple.
ObjectiveTo explore the effectiveness of dual-pedicle abdominal flap for unilateral breast reconstruction.MethodsBetween March 2014 and March 2018, a clinical data of 19 female patients underwent dual-pedicle abdominal flap reconstruction because of unilateral mastectomy defect was reviewed retrospectively. The median age was 45 years (range, 32-51 years), including 3 immediate breast reconstruction and 16 delayed breast reconstruction, and left side in 7 cases and right side in 12 cases. Unilateral breast reconstruction were performed for 8 patients with unilateral pedicle transverse rectus abdominis musculocutaneous (TRAM) flap and contralateral free TRAM flap, for 3 patients with pedicle TRAM flap and contralateral deep inferior epigastric perforator (DIEP) flap, for 7 patients with bilateral DIEP flaps, for 1 patient with free muscle-sparing TRAM flap and contralateral DIEP flap. The size of abdominal flap ranged from 24 cm×7 cm to 43 cm×13 cm. The donor sites were closed directly.ResultsVascular crisis ocuurred in 1 flap and relieved after surgical exploration. The other flaps survived. Poor wound healing in abdominal incision occurred in 1 patient and was successfully treated with debridement. The other donor sites healed without any other complication. The patients were followed up with a median period of 12 months (range, 4-42 months). Four patients received reparative operation of their reconstructive breast, and 2 patients received mamopexy of the contralateral breast due to mastoptosis. The abdominal BREAST-Q score was 84.1±11.7, chest score was 86.5±8.9, and breast score was 67.6±16.4 at last follow-up.ConclusionThe dual-pedicle abdominal flap for unilateral breast reconstruction provides adequate soft tissue volume and good blood supply. It is a reliable and effective breast reconstructive method for patients who need large tissue volume to make symmetric with the contralateral breast, or slim patients with few tissue in the donor site, or patients with scars in the donor site, especially vertical abdominal scars.