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.	張杰, 陳長松, 付勇強, 等. 脛前動脈化靜脈皮瓣修復趾背側軟組織缺損. 中華顯微外科雜志, 2012, 35(1):62-63.
2.	陳奇鳴, 羅錦輝, 楊福周, 等. 跗內側游離靜脈皮瓣修復手部軟組織缺損的臨床應用. 中華顯微外科雜志, 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.	吳迪, 利春葉, 周圍, 等. H型順行動脈化靜脈皮瓣的臨床應用. 中華手外科雜志, 2011, 27(1):56-57.
5.	周曉, 芮永軍, 許亞軍, 等. 雙干型靜脈皮瓣在撕脫性斷指再植中的應用. 中華手外科雜志, 2011, 27(2):81-83.
6.	伍美藝, 徐亞非, 梁偉強, 等. 帶掌長肌腱的改進雙干型動脈化靜脈皮瓣的應用. 中華顯微外科雜志, 2012, 35(4):330-331.
7.	楊衛東, 童致虹, 孫煥偉, 等. 動脈化靜脈皮瓣修復手指軟組織缺損. 中國修復重建外科雜志, 2007, 21(6):656-657.
8.	李瑞華, 闞世廉, 許效坤, 等. 動脈化靜脈皮瓣兩種灌流方式比較的實驗研究及臨床應用. 中華手外科雜志, 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.	潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3):130-135.
11.	劉春利, 魯開化, 吳宛堃, 等. 動脈化靜脈皮瓣壞死原因的探討及皮瓣改造. 中華整形燒傷外科雜志, 1994, 10(3):173-175.
12.	陳劍名, 梁建, 陳正耿. 動脈化靜脈皮瓣微循環方式的實驗研究. 中國修復重建外科雜志, 2002, 16(3):170-172.
13.	原林, 鐘世鎮. 皮瓣靜脈構筑及交通的應用解剖學研究. 中華顯微外科雜志, 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.	張杰, 陳長松, 陳旭華, 等. 帶感覺支指背側動脈化靜脈皮瓣移植修復指腹缺損. 中華骨科雜志, 2012, 32(4):344-347.
16.	龐水發, 常湘珍, 張方晨, 等. 皮瓣移植臨床應用應堅持原則. 中華顯微外科雜志, 2010, 33(1):1-2.
17.	張世民, 唐茂林, 章偉文, 等. 中國穿支皮瓣的名詞術語與臨床應用原則共識(暫定稿). 中華顯微外科雜志, 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. 張杰, 陳長松, 付勇強, 等. 脛前動脈化靜脈皮瓣修復趾背側軟組織缺損. 中華顯微外科雜志, 2012, 35(1):62-63.
2. 陳奇鳴, 羅錦輝, 楊福周, 等. 跗內側游離靜脈皮瓣修復手部軟組織缺損的臨床應用. 中華顯微外科雜志, 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. 吳迪, 利春葉, 周圍, 等. H型順行動脈化靜脈皮瓣的臨床應用. 中華手外科雜志, 2011, 27(1):56-57.
5. 周曉, 芮永軍, 許亞軍, 等. 雙干型靜脈皮瓣在撕脫性斷指再植中的應用. 中華手外科雜志, 2011, 27(2):81-83.
6. 伍美藝, 徐亞非, 梁偉強, 等. 帶掌長肌腱的改進雙干型動脈化靜脈皮瓣的應用. 中華顯微外科雜志, 2012, 35(4):330-331.
7. 楊衛東, 童致虹, 孫煥偉, 等. 動脈化靜脈皮瓣修復手指軟組織缺損. 中國修復重建外科雜志, 2007, 21(6):656-657.
8. 李瑞華, 闞世廉, 許效坤, 等. 動脈化靜脈皮瓣兩種灌流方式比較的實驗研究及臨床應用. 中華手外科雜志, 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. 潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3):130-135.
11. 劉春利, 魯開化, 吳宛堃, 等. 動脈化靜脈皮瓣壞死原因的探討及皮瓣改造. 中華整形燒傷外科雜志, 1994, 10(3):173-175.
12. 陳劍名, 梁建, 陳正耿. 動脈化靜脈皮瓣微循環方式的實驗研究. 中國修復重建外科雜志, 2002, 16(3):170-172.
13. 原林, 鐘世鎮. 皮瓣靜脈構筑及交通的應用解剖學研究. 中華顯微外科雜志, 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. 張杰, 陳長松, 陳旭華, 等. 帶感覺支指背側動脈化靜脈皮瓣移植修復指腹缺損. 中華骨科雜志, 2012, 32(4):344-347.
16. 龐水發, 常湘珍, 張方晨, 等. 皮瓣移植臨床應用應堅持原則. 中華顯微外科雜志, 2010, 33(1):1-2.
17. 張世民, 唐茂林, 章偉文, 等. 中國穿支皮瓣的名詞術語與臨床應用原則共識(暫定稿). 中華顯微外科雜志, 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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