Repair of large skin defect of upper limb with abdominal pedicled flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Ziyang ,  TANG Xiujun , WEI Zairong , JIN Wenhu , WANG Dali , WANG Bo , DENG Chengliang

Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China;

Corresponding?author：

TANG Xiujun, Email: xiujunsszx@163.com

Keywords：

Abdominal pedicled flap; perforator flap; improved suture; wound repair; upper limb

DOI：

10.7507/1002-1892.201703099

Video：

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Objective To investigate the feasibility and effectiveness of designing wide pedicle of abdominal pedicled flap and repairing large skin defect of upper limb with improved suture method. Methods Between March 2014 and August 2016, 11 cases with hand and forearm skin soft tissue defect were repaired with abdominal pedicled flaps. Among them, 8 cases were male and 3 were female; aged 18-65 years (mean, 38 years). The causes of injury were machinery injury in 7 cases and traffic accident in 4 cases. The wound located at left upper limb in 6 cases and right upper limb in 5 cases. The size of wound ranged from 12 cm×7 cm to 20 cm×10 cm. The interval from injury to operation was 2-5 days (mean, 4 days). Four cases were repaired with lower abdominal flap and 7 with umbilical flap. The size of flap ranged from 10 cm×9 cm to 22 cm×10 cm. And the flap was designed with wide pedicle at width of 8 to 18 cm (mean, 15 cm); then the wound was sutured with improved method. The pedicle was cut after 3 weeks. Results All the flaps survived without congestion, necrosis, and tension blisters. The wound and the incision were both healed at stage Ⅰ. All patients were followed up 4-12 months (mean, 8 months). The skin color, texture, and shape were satisfying, and no ulcer formed. Only line-like scar left at the donor site. Conclusion Abdominal pedicled flap with wide pedicle and improved suture method can reduce the abdominal skin waste, avoid postoperative infection, and be feasible to repair large skin defect of upper limb with advantages of simple operation and reliable fixation.

Citation： ZHANG Ziyang, TANG Xiujun, WEI Zairong, JIN Wenhu, WANG Dali, WANG Bo, DENG Chengliang. Repair of large skin defect of upper limb with abdominal pedicled flap. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1102-1105. doi: 10.7507/1002-1892.201703099 Copy

1.	韓軍濤, 謝松濤, 陶克, 等. 腹部窄蒂軸型皮瓣的設計及臨床應用. 中華損傷與修復雜志 (電子版), 2014, 9(4): 58-59.
2.	唐修俊, 魏在榮, 王波, 等. 改良帶蒂旋髂淺動脈皮瓣修復手部及前臂創面. 中國修復重建外科雜志, 2012, 26(8): 943-945.
3.	金文虎, 魏在榮, 鄧呈亮, 等. 游離旋股外側動脈降支穿支組織瓣的臨床應用及對供區影響觀察. 中國修復重建外科雜志, 2015, 29(10): 1284-1287.
4.	龐夢茹, 肖海濤, 王懷勝, 等. 應用不同皮瓣修復手掌重度瘢痕攣縮畸形的臨床分析. 中國修復重建外科雜志, 2016, 30(3): 382-384.
5.	張劍鋒, 王斌, 王輝, 等. 改良指固有動脈逆行島狀皮瓣與腹部超薄皮瓣修復遠節脫套傷的療效比較. 中國骨與關節損傷雜志, 2015, 30(11): 1178-1180.
6.	孫曉晨, 劉毅, 張緒生, 等. 腹部" 翼型”帶蒂皮瓣在手部創傷缺損修復術中的應用. 創傷外科雜志, 2016, 18(2): 117-118.
7.	官士兵, 孫文海, 李淑媛, 等. 髂腹股溝皮瓣聯合股部皮瓣帶蒂瓦合移植在手部大面積套脫傷治療中的應用. 中華手外科雜志, 2009, 25(2): 81-83.
8.	肖森, 劉光軍, 譚琪, 等. 上腹部雙葉帶蒂瓦合皮瓣修復手或前臂掌背側皮膚缺損. 中國修復重建外科雜志, 2015, 29(2): 194-197.
9.	劉利華. 復合組織瓣移植修復四肢嚴重創傷后皮膚缺損的臨床研究. 中國美容醫學, 2016, 25(9): 11-13.
10.	王進, 王慜, 徐媛, 等. 臍旁穿支皮瓣在手和前臂深度軟組織缺損修復中的應用. 組織工程與重建外科雜志, 2016, 12(4): 248-250.
11.	呂宏達, 王根林, 劉躍飛, 等. 三種手部創面移植皮瓣修復效果的評價. 中國組織工程研究, 2015, 19(24): 3929-3936.
12.	蒙家輝, 張文作, 曾業龍, 等. 腹部超薄皮瓣修復手部創面的遠期療效分析. 中華手外科雜志, 2009, 25(5): 290.
13.	Urushidate S, Yotsuyanagi T, Yamauchi M, et al. Modified thin abdominal wall flap (glove flap) for the treatment of acute burns to the hands and fingers. J Plast Reconstr Aesthet Surg, 2010, 63(4): 693-699.
14.	O’Shaughnessy KD, Rawlani V, Hijjawi JB, et al. Oblique pedicled paraumbilical perforator-based flap for reconstruction of complex proximal and mid-forearm defects: a report of two cases. J Hand Surg (Am), 2010, 35(7): 1105-1110.
15.	孫廣峰, 聶開瑜, 鄧呈亮, 等. 游離旋髂淺動脈穿支皮瓣修復足踝部皮膚軟組織缺損. 中國修復重建外科雜志, 2016, 30(11): 1396-1399.
16.	Shukla L, Taylor GI, Shayan R. The pedicled inferior paraumbilical perforator (I-PUP) flap for a volar wrist defect: a reconstructive solution across the ages. J Plast Reconstr Aesthet Surg, 2013, 66(11): 1613-1615.
17.	Krishnamoorthy R, Karthikeyan G. Degloving injuries of the hand. Indian J Plast Surg, 2011, 44(2): 227-236.
18.	Khandelwal S. An Abdominal Flap to Save the Right Forearm and the Hand, Following a High-voltage Electric Burn in a Child: A Case Report. J Clin Diagn Res, 2013, 7(7): 1473-1475.

1. 韓軍濤, 謝松濤, 陶克, 等. 腹部窄蒂軸型皮瓣的設計及臨床應用. 中華損傷與修復雜志 (電子版), 2014, 9(4): 58-59.
2. 唐修俊, 魏在榮, 王波, 等. 改良帶蒂旋髂淺動脈皮瓣修復手部及前臂創面. 中國修復重建外科雜志, 2012, 26(8): 943-945.
3. 金文虎, 魏在榮, 鄧呈亮, 等. 游離旋股外側動脈降支穿支組織瓣的臨床應用及對供區影響觀察. 中國修復重建外科雜志, 2015, 29(10): 1284-1287.
4. 龐夢茹, 肖海濤, 王懷勝, 等. 應用不同皮瓣修復手掌重度瘢痕攣縮畸形的臨床分析. 中國修復重建外科雜志, 2016, 30(3): 382-384.
5. 張劍鋒, 王斌, 王輝, 等. 改良指固有動脈逆行島狀皮瓣與腹部超薄皮瓣修復遠節脫套傷的療效比較. 中國骨與關節損傷雜志, 2015, 30(11): 1178-1180.
6. 孫曉晨, 劉毅, 張緒生, 等. 腹部" 翼型”帶蒂皮瓣在手部創傷缺損修復術中的應用. 創傷外科雜志, 2016, 18(2): 117-118.
7. 官士兵, 孫文海, 李淑媛, 等. 髂腹股溝皮瓣聯合股部皮瓣帶蒂瓦合移植在手部大面積套脫傷治療中的應用. 中華手外科雜志, 2009, 25(2): 81-83.
8. 肖森, 劉光軍, 譚琪, 等. 上腹部雙葉帶蒂瓦合皮瓣修復手或前臂掌背側皮膚缺損. 中國修復重建外科雜志, 2015, 29(2): 194-197.
9. 劉利華. 復合組織瓣移植修復四肢嚴重創傷后皮膚缺損的臨床研究. 中國美容醫學, 2016, 25(9): 11-13.
10. 王進, 王慜, 徐媛, 等. 臍旁穿支皮瓣在手和前臂深度軟組織缺損修復中的應用. 組織工程與重建外科雜志, 2016, 12(4): 248-250.
11. 呂宏達, 王根林, 劉躍飛, 等. 三種手部創面移植皮瓣修復效果的評價. 中國組織工程研究, 2015, 19(24): 3929-3936.
12. 蒙家輝, 張文作, 曾業龍, 等. 腹部超薄皮瓣修復手部創面的遠期療效分析. 中華手外科雜志, 2009, 25(5): 290.
13. Urushidate S, Yotsuyanagi T, Yamauchi M, et al. Modified thin abdominal wall flap (glove flap) for the treatment of acute burns to the hands and fingers. J Plast Reconstr Aesthet Surg, 2010, 63(4): 693-699.
14. O’Shaughnessy KD, Rawlani V, Hijjawi JB, et al. Oblique pedicled paraumbilical perforator-based flap for reconstruction of complex proximal and mid-forearm defects: a report of two cases. J Hand Surg (Am), 2010, 35(7): 1105-1110.
15. 孫廣峰, 聶開瑜, 鄧呈亮, 等. 游離旋髂淺動脈穿支皮瓣修復足踝部皮膚軟組織缺損. 中國修復重建外科雜志, 2016, 30(11): 1396-1399.
16. Shukla L, Taylor GI, Shayan R. The pedicled inferior paraumbilical perforator (I-PUP) flap for a volar wrist defect: a reconstructive solution across the ages. J Plast Reconstr Aesthet Surg, 2013, 66(11): 1613-1615.
17. Krishnamoorthy R, Karthikeyan G. Degloving injuries of the hand. Indian J Plast Surg, 2011, 44(2): 227-236.
18. Khandelwal S. An Abdominal Flap to Save the Right Forearm and the Hand, Following a High-voltage Electric Burn in a Child: A Case Report. J Clin Diagn Res, 2013, 7(7): 1473-1475.

Chinese Journal of Reparative and Reconstructive Surgery

Repair of large skin defect of upper limb with abdominal pedicled flap

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