FOREARM FREE ARTERIALIZED VENOUS FLAP IN REPAIRING SOFT TISSUE DEFECT OF HAND_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

BAIYinwei , LIZheng , YUShaoxiao , CHENZehua , KEYuhai , ZHOUWanggao , XIONGYi , ZHONGKeming ,  ZHANGZhenwei

Department of Hand Surgery, the Affiliated Shajing Hospital of Guangzhou Medical College, Shenzhen Guangdong, 518104, P. R. China;

Corresponding author：

ZHANGZhenwei, Email: zhangzw666@gmail.com

Keywords：

Forearm free flap; Arterialized venous flap; Soft tissue defect of hand; Wound repair

DOI：

10.7507/1002-1892.20140081

Video：

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Objective To observe the effectiveness of the forearm free arterialized venous flap in repairing soft tissue defect of the hand. Methods Between December 2008 and January 2013, 49 cases of soft tissue defects of the hand were treated. There were 39 males and 10 females, aged 16-52 years (mean, 34 years). Defect was caused by crush injury in 34 cases, cutting injury in 7 cases, avulsion injury in 5 cases, and hot crush injury in 3 cases. The locations were index finger in 21 cases, middle finger in 14 cases, ring finger in 10 cases, little finger in 1 case, and the first web space and the dorsal palm in 3 cases. The duration of injury and admission was 2-10 hours (mean, 4.5 hours). The size of defects ranged from 2.5 cm×1.5 cm to 6.0 cm×4.5 cm. Of them, 46 cases had fracture of metacarpal or finger bone and/or injury of tendon and nerve. Emergency operation was performed in 43 cases and selective operation in 6 cases. All defects were repaired by free arterialized venous flap from the ipsilateral forearm, in which the proximal ends of veins were anastomosed to artery and vein of the finger. The flap size ranged from 3.5 cm×2.5 cm to 7.5 cm×5.3 cm. The donor site was directly sutured. Results Seven flaps survived which was similar to physiological free flap. Mild or medium swelling and blister were observed in 39 flaps and heavy swelling and partial necrosis occurred in 3 flaps after operation. The patients were followed up 6 months-2 years (mean, 13.5 months). The flaps had soft texture, slightly bulky appearance, and deeper color than normal skin. At last follow-up, the two-point discrimination was 16-22 mm (mean, 20 mm). According to the standard for functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the results were excellent in 21 cases, good in 21 cases, fair in 3 cases, and poor in 4 cases. Conclusion It is an ideal method to repair soft tissue defect of the hand to use forearm free arterialized venous flap. It has the advantages of massive area, no major blood vessel needed to be sacrificed, safe and easy operation, and satisfactory appearance.

Citation： BAIYinwei, LIZheng, YUShaoxiao, CHENZehua, KEYuhai, ZHOUWanggao, XIONGYi, ZHONGKeming, ZHANGZhenwei. FOREARM FREE ARTERIALIZED VENOUS FLAP IN REPAIRING SOFT TISSUE DEFECT OF HAND. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(3): 362-365. doi: 10.7507/1002-1892.20140081 Copy

1.	张杰, 陈长松, 付勇强, 等. 胫前动脉化静脉皮瓣修复趾背侧软组织缺损. 中华显微外科杂志, 2012, 35(1):62-63.
2.	陈奇鸣, 罗锦辉, 杨福周, 等. 跗内侧游离静脉皮瓣修复手部软组织缺损的临床应用. 中华显微外科杂志, 2012, 35(2):158-160.
3.	Kong BS, Kim YJ, Sun YJ, et al. Finger soft tissue reconstruction using arterialized venous free flaps having 2 parallel veins. J Hand Surg (Am), 2008, 33(10):1802-1806.
4.	吴迪, 利春叶, 周围, 等. H型顺行动脉化静脉皮瓣的临床应用. 中华手外科杂志, 2011, 27(1):56-57.
5.	周晓, 芮永军, 许亚军, 等. 双干型静脉皮瓣在撕脱性断指再植中的应用. 中华手外科杂志, 2011, 27(2):81-83.
6.	伍美艺, 徐亚非, 梁伟强, 等. 带掌长肌腱的改进双干型动脉化静脉皮瓣的应用. 中华显微外科杂志, 2012, 35(4):330-331.
7.	杨卫东, 童致虹, 孙焕伟, 等. 动脉化静脉皮瓣修复手指软组织缺损. 中国修复重建外科杂志, 2007, 21(6):656-657.
8.	李瑞华, 阚世廉, 许效坤, 等. 动脉化静脉皮瓣两种灌流方式比较的实验研究及临床应用. 中华手外科杂志, 2006, 22(4):242-244.
9.	Pittet B, Quinodoz P, Alizadeh N, et al. Optimizing the arterialized venous flap. Plast Reconstr Surg, 2008, 122(6):1681-1689.
10.	潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3):130-135.
11.	刘春利, 鲁开化, 吴宛堃, 等. 动脉化静脉皮瓣坏死原因的探讨及皮瓣改造. 中华整形烧伤外科杂志, 1994, 10(3):173-175.
12.	陈剑名, 梁建, 陈正耿. 动脉化静脉皮瓣微循环方式的实验研究. 中国修复重建外科杂志, 2002, 16(3):170-172.
13.	原林, 钟世镇. 皮瓣静脉构筑及交通的应用解剖学研究. 中华显微外科杂志, 1991, 14(3):163-165.
14.	Nakajima H, Imanishi N, Aiso S, et al. Venous drainage of the radial forearm and anterior tibial reverse flow flaps:anatomical and radiographic perfusion studies. Br J Plast Surg, 1997, 50(6):389-401.
15.	张杰, 陈长松, 陈旭华, 等. 带感觉支指背侧动脉化静脉皮瓣移植修复指腹缺损. 中华骨科杂志, 2012, 32(4):344-347.
16.	庞水发, 常湘珍, 张方晨, 等. 皮瓣移植临床应用应坚持原则. 中华显微外科杂志, 2010, 33(1):1-2.
17.	张世民, 唐茂林, 章伟文, 等. 中国穿支皮瓣的名词术语与临床应用原则共识(暂定稿). 中华显微外科杂志, 2012, 35(2):89-92.
18.	Lin YT, Henry SL, Lin CH, et al. The shunt-restricted arterialized venous flap for hand/digit reconstruction:enhanced perfusion, decreased congestion, and improved reliability. Trauma, 2010, 69(2):399-404.

1. 张杰, 陈长松, 付勇强, 等. 胫前动脉化静脉皮瓣修复趾背侧软组织缺损. 中华显微外科杂志, 2012, 35(1):62-63.
2. 陈奇鸣, 罗锦辉, 杨福周, 等. 跗内侧游离静脉皮瓣修复手部软组织缺损的临床应用. 中华显微外科杂志, 2012, 35(2):158-160.
3. Kong BS, Kim YJ, Sun YJ, et al. Finger soft tissue reconstruction using arterialized venous free flaps having 2 parallel veins. J Hand Surg (Am), 2008, 33(10):1802-1806.
4. 吴迪, 利春叶, 周围, 等. H型顺行动脉化静脉皮瓣的临床应用. 中华手外科杂志, 2011, 27(1):56-57.
5. 周晓, 芮永军, 许亚军, 等. 双干型静脉皮瓣在撕脱性断指再植中的应用. 中华手外科杂志, 2011, 27(2):81-83.
6. 伍美艺, 徐亚非, 梁伟强, 等. 带掌长肌腱的改进双干型动脉化静脉皮瓣的应用. 中华显微外科杂志, 2012, 35(4):330-331.
7. 杨卫东, 童致虹, 孙焕伟, 等. 动脉化静脉皮瓣修复手指软组织缺损. 中国修复重建外科杂志, 2007, 21(6):656-657.
8. 李瑞华, 阚世廉, 许效坤, 等. 动脉化静脉皮瓣两种灌流方式比较的实验研究及临床应用. 中华手外科杂志, 2006, 22(4):242-244.
9. Pittet B, Quinodoz P, Alizadeh N, et al. Optimizing the arterialized venous flap. Plast Reconstr Surg, 2008, 122(6):1681-1689.
10. 潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3):130-135.
11. 刘春利, 鲁开化, 吴宛堃, 等. 动脉化静脉皮瓣坏死原因的探讨及皮瓣改造. 中华整形烧伤外科杂志, 1994, 10(3):173-175.
12. 陈剑名, 梁建, 陈正耿. 动脉化静脉皮瓣微循环方式的实验研究. 中国修复重建外科杂志, 2002, 16(3):170-172.
13. 原林, 钟世镇. 皮瓣静脉构筑及交通的应用解剖学研究. 中华显微外科杂志, 1991, 14(3):163-165.
14. Nakajima H, Imanishi N, Aiso S, et al. Venous drainage of the radial forearm and anterior tibial reverse flow flaps:anatomical and radiographic perfusion studies. Br J Plast Surg, 1997, 50(6):389-401.
15. 张杰, 陈长松, 陈旭华, 等. 带感觉支指背侧动脉化静脉皮瓣移植修复指腹缺损. 中华骨科杂志, 2012, 32(4):344-347.
16. 庞水发, 常湘珍, 张方晨, 等. 皮瓣移植临床应用应坚持原则. 中华显微外科杂志, 2010, 33(1):1-2.
17. 张世民, 唐茂林, 章伟文, 等. 中国穿支皮瓣的名词术语与临床应用原则共识(暂定稿). 中华显微外科杂志, 2012, 35(2):89-92.
18. Lin YT, Henry SL, Lin CH, et al. The shunt-restricted arterialized venous flap for hand/digit reconstruction:enhanced perfusion, decreased congestion, and improved reliability. Trauma, 2010, 69(2):399-404.

Chinese Journal of Reparative and Reconstructive Surgery

FOREARM FREE ARTERIALIZED VENOUS FLAP IN REPAIRING SOFT TISSUE DEFECT OF HAND

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