三种主力皮瓣,无锡手外科医院强力制作.pptVIP

New workhorse flaps in hand reconstruction JeffreyB.Friedrich WilliamC.Pederson AllenT.Bishop HAND(2012)7:45-54 Introduction The term “workhorse flap” is commonly used in hand surgery and microsurgery. Definition: something that is markedly useful,durable,or dependable. Workhorse flap can be defined as one that has dependable anatomy, ease of harvest and inset, multiple applications, and multiple users. Introduction In this review, three common hand problems are highlighted: (1) dorsal hand wound. (2) extensive mutilating hand injury. (3) scaphoid nonunion.   Dorsal hand wound A dorsal hand wound is a common injury because of the thin pliable nature of the skin. Trauma to this skin will result in exposed extensor tendons and metacarpal bones. The current accepted treatment is a reverse flow radial artery pedicled forearm flap. Shortcomings: poor skin graft take on the donor site and noticeable donor scar. leads to a bulky “biscuit-like” result . An new workhorse flap would be the radial forearm fascia-only flap. Radial Forearm Fascia Flap Anatomy : The limited anatomic research that has been performed. We know from experience the perfusion of the flap is adequate at least for a skin graft applied directly to the flap. Solves two problems:poor appearance of the donor site and flap bulkiness at the recipient site. Radial Forearm Fascia Flap Indications : Any dorsal hand wound and just about any thumb wound . Difficult to make the flap reach the fingertips. Fracture fixation and extensor tendon repair or reconstruction can be performed and the flap used to cover the dorsalhand at the same time. Radial Forearm Fascia Flap Severe dorsal hand injury that includes extensor indicis proprius, extensor digitorum communis (index), extensor carpi radialis longus and brevis, and skin loss. Radial Forearm Fascia Flap Dissection of the deep surface of the flap and th