脐旁穿孔器皮瓣:覆盖前臂和手部软组织缺损的可靠选择

Mymensingh medical journal : MMJ Pub Date : 2024-07-01
A Sarker, S R Faruquee, R M Manzur, K N A Begum, O Z M Dastagir, M A Ali
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引用次数: 0

摘要

手部或前臂软组织损伤通常会导致肌腱或骨骼外露,需要用合适的皮瓣覆盖。这项前瞻性观察研究于 2019 年 2 月至 2020 年 1 月在孟加拉国达卡国立创伤和骨科康复研究所(NITOR)进行,旨在评估带蒂脐旁穿孔器皮瓣作为覆盖此类缺损的可靠皮瓣的使用情况。共有34名手部和前臂软组织缺损且肌腱、骨骼或植入物外露的患者参与了这项研究。所有缺损均由脐旁穿孔器皮瓣覆盖。缺损的原因包括道路交通事故(22 例)、机械损伤(10 例)和烧伤(2 例)。16例患者的缺损涉及前臂,6例涉及手背,2例涉及第一蹼间隙,其余患者的缺损涉及前臂、手部和腕部的两个或多个区域。在 41.18% 的病例中,皮瓣的外侧范围可达腋前线,在 55.88% 的病例中,皮瓣的外侧范围可达腋中线。皮瓣分割和最终嵌入在 3 周后的第二阶段完成。所有病例的供皮部位都基本闭合,只有两个病例的供皮部位被植皮覆盖。所有皮瓣在第一阶段后都存活了下来,没有发生皮瓣坏死、开裂或感染。然而,在皮瓣分割后,两名患者的近端边缘出现了边缘坏死,经保守治疗后自愈。使用的皮瓣平均面积为 108 平方厘米。供区愈合良好,无任何重大并发症。三名疤痕肥大患者接受了皮下注射曲安奈德的治疗。脐旁穿孔肌皮瓣是覆盖手部和前臂软组织缺损的可靠选择,因为它更容易规划和采集皮瓣,有足够的皮肤瓣和最低的供区发病率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Paraumbilical Perforator Flap: A Reliable Option for Coverage of Soft Tissue Defects of Forearm and Hand.

Soft tissue injuries of the hand or forearm often results in exposure of tendon or bone which needs coverage with a suitable flap. This prospective observational study was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from February 2019 to January 2020, to evaluate the use of the pedicled paraumbilical perforator flaps as a reliable flap to cover such defects. Total 34 patients having soft tissue defects in the hand and forearm with exposed tendons, bones or implant were included in this study. All the defects were covered by paraumbilical perforator flap. The defects were caused by road traffic accident (n=22), machinery injury (n=10) and burn injury (n=2). Sixteen patients had defects involving the forearm, six over dorsum of hand, another two over first web space and the rest had defects over two or more areas of forearm, hand and wrist. Lateral extent of flaps was upto anterior axillary line in 41.18% cases and upto mid-axillary line in 55.88% cases. Flap division and final inset was done in second stage after 3 weeks. Donor site closed primarily in all cases, except in two cases where it was covered by skin graft. All the flaps survived with no incidence of flap necrosis, dehiscence or infection after first stage. However, after the division of the flap, two patients developed marginal necrosis of the proximal margin which healed spontaneously by conservative treatment. The mean flap surface area utilized was 108 cm2. Donor area healed well without any major complications. Three patients developing scar hypertrophy were treated with intra-lesional triamcinolone injections. The paraumbilical perforator flap is a reliable option to cover soft tissue defects of hand and forearm due to easier planning and harvesting of the flap, adequate skin paddle and minimum donor site morbidity.

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