Forearm radial artery retrograde island (fascial) flap transplantation

The main blood supply to the temporal skin of the forearm comes from the radial artery and its cutaneous branch. The radial artery sends about 14 cutaneous branches in the forearm, from the inside and outside of the artery. There are two groups in the shallow and deep sections. The former is about 10 and has large cutaneous branches. It is distributed at the lateral side of the radial artery 5 cm above the styloid process of the humerus. It is also the main cutaneous branch of the radial artery flap. The vein of the flap has the venous and cephalic veins of the radial artery, with the vein being the main reflux vein of the flap. The flap has a superficial branch of the radial nerve and a lateral cutaneous nerve of the forearm. Treatment of diseases: forearm artery injury Indication Due to acute trauma, the skin of the palm of the hand is deficient and the deep tissue is exposed. When other flaps are difficult to close the wound or affect the appearance, the forearm radial artery can be used to cover the island fascia flap or flap. Surgical procedure Take the palm skin defect as an example. 1. flap design The intersection of the proximal wrist transverse line and the radial artery is the rotation axis, and the distance from the proximal edge of the hand to the axis is the length of the vascular pedicle. The point is measured along the axis of the radial artery to the proximal end, and then in the vicinity. The end is designed with the desired flap centered on the axis of the radial artery. 2. Flap cutting An "S"-shaped incision is made between the distal edge of the designed flap and the intersection of the radial artery and the transverse line of the wrist. The axillary and vein are found in the intermuscular space of the diaphragm and the radial flexor digitorum. Muscle interstitial vessels, cut off branches that are not associated with the flap, separate the iliac and vein from the deep layer, cut the skin along the flap to cut the skin directly to the deep fascia, and lift the flap from the deep fascia on both sides, toward the iliac crest The blood vessels are close together, the ligature of the ligature is cut off, and the lower iliac crest and arteriovenous vein are separated from the deep layer. The proximal end of the flap is blocked by the blood vessel clip, and the blood circulation of the flap is observed. If normal, the iliac crest is cut at a high position. The blood vessels are picked up together with the flaps to the distal end. Make an arc-shaped incision between the wrist incision and the volar wound edge and separate the two sides of the skin. The flap and the vascular pedicle are 180° reversed to the volar side of the wound with the rotation axis as the center, and the blood vessel is buried in the subcutaneous suture skin. The forearm wound was taken by medium-thickness skin grafting and pressure-wrapped. The forearm radial artery retrograde island fascia flap was cut: the design of the fascial flap was the same as that of the forearm radial artery retrograde island flap, and the cut was similar. The only difference was only two: 1 fascial flap skin incision from wrist transverse stripes to The apex of the flap was cut open, and 1 to 2 mm thick fat was left under the dermis for sneak sharp peeling until the edge of the fascial flap design, and then the deep fascia was cut to make the deep fascia and the vascular pedicle together; 2 fascia The flap was 180° reversed by subcutaneous tunnel or skin incision, and the needle was resected to the hand wound and the surrounding soft tissue was sutured to fix several needles. The medium-thickness skin graft was pressure-wrapped and the forearm incision was directly sutured. The advantage of the fascial flap is that it not only covers the wound surface, but also does not damage the shape of the forearm.