张力对改良前臂皮瓣供区恢复的影响

目的探讨张力对改良前臂皮瓣(使用前臂供区皮片关闭前臂术创)供区恢复的影响。方法对2018年10月至2021年4月于徐州市中心医院就诊的12名经前臂皮瓣修复的口腔癌患者,术前记录患者双手握力及腕关节活动度,前臂供区关创,使用前臂供区的三角形全厚皮片关闭部分术创,另一部分术创直接拉拢缝合,供区关创时用拉力计测量张力。术后对患者进行随访,观察患者术后供区创口有无坏死、愈合不良等并发症及供区侧前臂握力及腕关节活动度、外形满意度。结果 12例患者中仅1例高龄患者术后供区皮片近腕侧坏死情况,该患者平均张力为0.65 kg,经换药后二期愈合;其余患者术后供区未出现并发症。12例患者平均张力大小为(0.51±0.05)kg。12例患者术前术后握力分别为(23.7±10.3)kg、(22.3±10.7)kg,差异无统计学意义(t=5.872,P<0.001);术前术后腕关节活动度分别为掌屈(47.6±8.3)°、(45.8±5.8)°;背伸(54.6±3.2)°、(53.9±2.3)°;桡偏(37.0±2.3)°、(36.1±2.2)°;尺偏(27.1±1.9)°、(26.4±1.3)°。四个方向...     

桡侧蒂旋转推进筋膜皮瓣修复前臂皮瓣供区缺损

目的探讨桡侧蒂旋转推进筋膜皮瓣关闭前臂皮瓣切取术后供区缺损的可行性与临床应用价值。方法2014年11月-2015年5月采用桡侧蒂旋转推进筋膜皮瓣对36例患者行桡侧前臂皮瓣切取后的供区缺损进行修复。其中男性28例,女性8例。年龄28~67岁,平均年龄53.6岁,皮瓣大小为3.0 cm×5.0 cm~4.0 cm×6.0 cm。术后定期随访,对切口愈合、瘢痕增生及前臂外观等情况进行记录和评价。术后3个月和6个月分别测量腕关节的掌屈、背伸、尺偏、桡偏角度,计算腕关节失能指数,并与术前对比,评估腕关节功能恢复状况。采用SPSS 19.0统计软件包中的配对t检验进行统计学分析。结果36例患者前臂皮瓣切取后产生的供区创面均采用桡侧蒂旋转推进筋膜皮瓣顺利关闭而无需植皮。其中5例患者术后因切缘张力过大发生缺血性改变,表皮剥脱后色素丧失,但切口愈合未受影响。术后随访6~12个月期间,所有患者前臂切口均未见明显瘢痕增生,外观满意。术后3个月和6个月,患者腕关节的掌屈、背伸、尺偏、桡偏角度及腕关节失能指数与术前比较差异无统计学意义（P>0.05）。结论应用桡侧蒂旋转推进筋膜皮瓣能够直接关闭中小型前臂皮瓣切取后供区缺损,术后外观满意且不会对腕关节功能产生不良影响,值得临床推广应用。     

股前外侧皮瓣与前臂桡侧皮瓣修复口腔缺损：皮瓣供区并发症的比较

临床上,股前外侧皮瓣（tALT）用于修复软组织缺损有不损伤大动脉的风险，功能及美学效果好等优点，该文旨在评价股前外侧皮瓣与前臂桡侧皮瓣（RFFF）修复口腔缺损后供区的美学效果。对2003年1月-2005年9月收治的42例口腔鳞癌患者进行回顾性研究，男27例，女15例，平均年龄61．4岁，所有患者接受显微外科组织重建。17例应用RFFF。25例应用tALT。结果：RFFF组成功率94．2％。     

浓缩生长因子对前臂皮瓣供区术后感觉功能恢复的影响

目的 探讨浓缩生长因子(concentrated growth factor,CGF)对前臂皮瓣供区术后感觉恢复的影响.方法 回顾性分析2019年7月至2020年7月南京医科大学附属口腔医院采用前臂皮瓣修复颌面部缺损的30例患者,其中试验组16例,对照组14例.试验组术中制备CGF,覆盖于暴露的桡神经上,对照组不做处理...     

应用近红外光谱监测前臂皮瓣供区术后血运变化

目的：利用近红外光谱技术对前臂皮瓣供区术前及术后的血氧饱和度（SO2）进行监测,总结前臂桡侧皮瓣制备术后供区SO2的变化规律,探讨前臂桡侧皮瓣制备术对供区血运的影响。方法：临床上接受前臂皮瓣制备术的患者35例,选择前掌大鱼际、小鱼际作为前臂皮瓣供区监测部位。自术前1天至术后第7天,用近红外光谱血氧检测仪（TSAH-100）对供区和对侧相同监测部位的SO2进行监测,术后24 h内每4 h 1次,术后24 h后每天2次,持续至术后第7天。采用SPSS13.0软件包对大鱼际和小鱼际的SO2进行配对t检验,分析两者之间的差异。结果：前臂皮瓣供区大鱼际和小鱼际的SO2均呈现由低于对侧水平上升至高于对侧水平,然后逐渐下降至术前初始水平的变化特点。供区小鱼际SO2在术后20 h达到峰值,与对侧小鱼际相比有显著差异（P〈0.05）。供区大鱼际SO2在术后24 h达到峰值,术后12 h和术后48 h与对侧相差幅度较大,有显著差异（P〈0.05）。术后第7天,供区大鱼际和小鱼际SO2较对侧无显著差异（P〉0.05）。结论：前臂桡侧皮瓣制备术对其供区组织的血运产生了一定程度的影响。在无桡动脉和头静脉变异的情况下,桡动脉与尺动脉之间的交通支循环能保证前臂桡侧皮瓣术后供区的血流灌注量,其血运在术后6~7 d内基本恢复至术前状态。     

颏下岛状皮瓣与前臂皮瓣修复口腔鳞癌术后缺损的比较

目的：比较颏下岛状皮瓣与游离前臂皮瓣修复口腔鳞癌术后缺损的结果。方法：2009年5月~2011年8月,69例口腔鳞癌术后缺损采用颏下岛状皮瓣或游离前臂皮瓣修复,比较2种修复方法的皮瓣大小、手术时间、住院时间、并发症、口腔功能恢复及复发情况。结果：69例患者中,采用颏下岛状皮瓣修复32例,游离前臂皮瓣修复37例。颏下岛状皮瓣组与游离前臂皮瓣组在平均皮瓣大小（32.78cm2 VS 48.27cm2）、平均手术时间（351min VS 508min）、平均住院日（13.06dVS 17.48d）等均有统计学差异（P〈0.001）;两组患者总的并发症发生相似,但颏下岛状皮瓣组发生颌下区积液的比例较高（P〈0.05）;两组患者在术后口腔功能恢复及肿瘤复发方面无差异。结论：颏下岛状皮瓣修复可明显缩短手术时间及患者住院时间,可作为口腔鳞癌术后中小型缺损修复的首选。     

前臂桡侧皮瓣内动静脉吻合解救静脉回流障碍1例报告

前臂桡侧皮瓣是一种多功能性皮瓣，由于其皮下脂肪较少，皮瓣薄而柔软，利于成形。对舌、口底及面颊缺损的修复为首选，且成功率较高。最近，我科实施1例前臂皮瓣修复舌缺损手术，手术过程中，发现头静脉回流障碍，我们采取了皮瓣内桡动脉与头静脉吻合的方式解救静脉回流障碍，并使皮瓣成活。现报告如下。     

前臂桡侧皮瓣与股前外侧皮瓣修复半舌缺损的比较研究

目的：分析比较前臂桡侧皮瓣与股前外侧皮瓣在修复半舌缺损后的舌功能恢复和供受区并发症情况。方法：2008年7月-2012年11月,23例舌癌患者接受肿瘤扩大切除,遗留的半舌缺损,14例采用前臂桡侧皮瓣修复,供区伤口取腹部全厚皮片移植修复;9例采用股前外侧皮瓣修复。术后4~6个月,对每例患者的吞咽功能、语言清晰度和供受区并发症等情况进行随访分析。结果：前臂桡侧皮瓣组和股前外侧皮瓣组患者吞咽功能和语言清晰度均恢复良好,两组之间无显著差异。在受区,前臂桡侧皮瓣组有1例出现全部皮瓣坏死;股前外侧皮瓣组有1例出现小部分皮瓣坏死,1例出现口颈瘘。在供区,前臂桡侧皮瓣组有4例出现移植皮片部分坏死,1例伤口部分裂开,12例出现明显的瘢痕,9例局部麻木,3例手臂功能障碍;股前外侧皮瓣组有1例局部麻木,1例出现明显的瘢痕,均未出现运动功能障碍。前臂桡侧皮瓣组供区并发症明显多于股前外侧皮瓣组。结论：股前外侧皮瓣可获得的血管蒂长、管径大、供区并发症少,是半舌缺损较理想的修复组织瓣。     

游离桡侧前臂皮瓣及桡侧前臂骨皮瓣在头颈缺损修复中的应用

游离桡侧前臂皮瓣(radial forearm free flap,RFFF)是目前头颈部缺损修复应用最广的游离皮瓣,由我国学者杨果凡于1978年最早应用于临床[1],因而又被称为中国瓣(Chineseflap)。该皮瓣最早被应用于四肢瘢痕挛缩的治疗,但很快就被应用到头颈缺损的修复与重建,并成为目前应用最多的     

前臂桡侧游离皮瓣在颌面部应用的体会

前臂桡侧游离皮瓣在颌面部应用的体会镇江医学院附属医院口腔科王海宁，马迎春，王陈上海第二医科大学附属第九人民医院口腔颌面外科竺涵光，张陈平随着显微外科的发展，采用血管吻合技术远距离组织移植即刻修复颌面部组织缺损，已广泛应用于临床，而在颌面部应用最多的则...     

Donor site morbidity after vascularized fibula free flap: gait analysis during prolonged walk conditions

The aim of this study was to determine the effect of vascularized fibula free flap (VFFF) harvest on gait variables during the six-minute walk test (6MWT). Eleven patients who had undergone VFFF harvest and 11 healthy peers participated in this case–control study. The main evaluation consisted of the collection of gait variables using the GAITRite system during three periods of the 6MWT: beginning (0–1 min), middle (2:30–3:30 min), and end (5–6 min). The 6MWT was significantly shorter in the VFFF group than in the reference group (?31%, P < 0.001). Most gait variables differed significantly between the groups for each period (P-value range 0.04–0.0004), including toe in/out on the operated side (P-value range 0.005–0.01). The increase in toe in/out on the operated side suggests a functional modification caused by an imbalance of the agonist–antagonist muscles. On comparison of the different periods, gait velocity decreased between the beginning and middle periods and increased between the middle and end periods in both groups. However, a significantly lower velocity between the beginning and end periods was found only for the VFFF group (P = 0.026), suggesting an alteration in physical management. In conclusion, these results suggest that VFFF harvesting could alter gait and joint integrity.     

前臂游离全厚皮片修复前臂游离皮瓣供区缺损的临床观察

目的:观察同侧前臂局部全厚皮片修复前臂游离皮瓣切取后供区缺损的临床效果。方法:27例口腔鳞癌患者,所取前臂皮瓣最小为5cm×6cm,最大为6cm×9cm。前臂皮瓣取下后,按设计在前臂近心端切取三角形不含皮下组织的全厚皮片。关闭伤口时,从近心端向远心端进行,一直到术前设计时指定的一点,剩余三角形区域用切取的全厚皮片覆盖。结果:所有患者移植皮片成活良好,并且获得良好的外观。结论:本方法所植皮片的颜色与周围正常皮肤组织接近,不增加创伤,不增加并发症,不影响功能,具有一定的优势。     

Retrospective comparison of split-thickness skin graft versus local full-thickness skin graft coverage of radial forearm free flap donor site

The study aimed at comparing outcomes between split-thickness skin graft (STSG) and local ipsilateral full-thickness skin graft (FTSG) after radial forearm free flap defect closure.A comprehensive study protocol for objective and subjective assessment was established for this retrospective, single-center study. Clinical examinations were carried out, encompassing measuring wrist and finger range of movement and grip strength, testing skin sensitivity, and evaluating aesthetics using the Patient and Observer Scar Assessment Scale (POSAS). In addition, medical history, and questionnaire, including Cold Intolerance Severity Score (CISS) and 18 items, were used to assess satisfaction, functional limitations, and complaints.44 patients were examined, and 40 patients included, who had received STSG (group 1; n = 19) respectively local FTSG from the ipsilateral forearm (group 2; n = 21) at least three months previously. Significantly lower values for parameters pigmentation, relief (p = 0.015), overall impression (p = 0.044), as well as mean POSAS observer scale total score (p = 0.046) and no complaints wearing a wristwatch (p = 0.012) were shown in group 2 (FTSG).Within the limitations of the study, it seems that FTSG harvested from the forearm should be preferred over STSG to cover RFFF donor site whenever appropriate, because of beneficial outcomes, while providing single intervention closure and avoiding secondary donor site.     

Donor site angiography before mandibular reconstruction with fibula free flap.

The use of fibular free flaps has become established as a reliable and popular method for reconstruction of segmental mandibular defects. The role of routine preoperative angiography remains controversial. Sixty four digital subtraction angiograms were studied in a series of 39 consecutive patients clinically judged to be satisfactory candidates for fibula free transfer. Angiographic findings revealed vascular anomalies in 10 extremities (15.6%). Regarding the high potential for significant donor site morbidity authors consider vascular imaging essential part of preoperative evaluation.     

The radial forearm free flap: our experience in solving donor site problems.

Special attention is paid to the problems of the donor site (the forearm) in a series of 75 patients who underwent orofacial malignancy excision. An island skin flap from the ulnar aspect of the forearm, used in 15 patients, is reported to be an improvement of the surgical technique. No healing complications were observed, and the aesthetic and functional results were very good.     

“迷你”负压引流在前臂游离皮瓣移植供区缺损修复中的应用

目的: 探讨“迷你”负压引流在前臂游离皮瓣移植供区缺损修复中的应用效果。方法: 选择口腔颌面部恶性肿瘤患者44例,均接受前臂游离皮瓣移植同期修复肿瘤切除术后缺损,采用腹部全厚皮片修复前臂供区缺损,分别应用“迷你”负压引流法（22例）和传统加压法（22例）。观察评估术后前臂区域引流量、移植皮片愈合情况和患者主观满意程度,采用SAS 9.4软件包对数据进行统计学分析。结果: “迷你”负压引流组22例患者中,20例皮片完全成活,创面平整,愈合良好,无结痂、渗出及感染;2例皮片边缘部分坏死,简单清理换药后痊愈。传统加压组22例患者中,18例皮片完全成活,4例出现部分坏死。术后随访6~10个月,“迷你”负压引流组皮片颜色接近正常皮色,手部运动、感觉功能正常,患者主观满意度显著高于传统加压组（P<0.05）。结论: “迷你”负压引流应用于前臂皮瓣制备后缺损的植皮修复,安全有效,成本低廉,患者满意舒适度高,值得临床推广应用。     

Function of the sensate free forearm flap after partial glossectomy.

AIMS: To compare functional recovery of sensitive free forearm flaps with non-sensitive free forearm flaps, following reconstruction for partial glossectomy. MATERIAL: Sixteen patients underwent partial glossectomy for oncological reasons, of whom: nine patients underwent repair with non-sensitive free forearm flaps (group A) and seven with sensitive free flaps (group B). METHODS: All patients underwent the following tests: (1) tactile sensitivity evaluation, localization of stimulus, sharp/blunt definition, discrimination between two points (static and dynamic), thermal sensitivity to heat/cold; (2) speech evaluation by means of the modified Fanzago test; (3) subjective evaluation concerning the degree of satisfaction of the following functions: swallowing, feeding and talking. RESULTS: The sensitivity and logopaedic evaluation tests and the subjective evaluation charts highlight an overall better functional recovery of the sensitive repair than the non-sensitive ones. CONCLUSION: In patients who have undergone partial glossectomy repair with free forearm neurofasciocutaneous flaps allow good recovery of oral functions and, therefore, a good quality of life.     

Closure of radial forearm free flap donor site with local full-thickness skin graft.

A triangular shaped full-thickness skin graft harvested adjacent to the donor site of the radial forearm flap, as originally described by Liang et al, has successfully been used in seven consecutive patients for coverage of the donor site of the radial forearm free flap. In all patients this resulted in a robust coverage with no late wound breakdown and an aesthetic appearance far superior to split-thickness skin-graft coverage. We recommend this technique which is feasible in the majority of cases and reduces both donor site and graft site morbidity of the radial forearm flap.