Abstract：
Although the palm is spared mostly in severe burn injuries, it often is affected in children and requires radical excision of contracting scar tissue to allow normal hand development. Since alternatives are limited for palmar coverage, we primarily use a reverse-perfused, neurocutaneous dorsal ulnar artery flap. We report here our long-term follow-up results.
We reviewed the long-term results of 10 postburn palmar contracture release and flap coverage procedures in 10 children. The applied flap was based distally on the dorsal branch of the ulnar artery and harvested along the ulnar aspect of the hand and wrist. The pivot point of the flap was located dorsally, close to the 4th and 5th metacarpal base. Patients were followed for a median period of 6 years (range, 4-20 years).
Flap size ranged from 60-130 mm in length and 20-35 mm in width. This variation in flap dimensions resulted from different hand sizes, because of the various patient ages at surgery. All flaps survived, donor site healing was uneventful, and marginal flap necrosis occurred only once. Satisfactory restoration of range of motion without secondary contractures was observed. Moreover, we detected adequate progressive growth, adaptability and sensory recovery in all flaps. Over time, the flaps mostly become hairless and progressively flattened without debulking.
The importance of this flap lies in the potential for considerable tissue mobilization to cover palmar defects without sacrificing any major vascular axis. The adequate progressive growth of the flap facilitates functional hand development in children. The predictable vascular anatomy, wide range, and durable, thin, and pliable skin make the reverse neurocutaneous dorsal ulnar artery flap an appealing option for soft tissue reconstruction of the palm in children.
Therapeutic V.
We reviewed the long-term results of 10 postburn palmar contracture release and flap coverage procedures in 10 children. The applied flap was based distally on the dorsal branch of the ulnar artery and harvested along the ulnar aspect of the hand and wrist. The pivot point of the flap was located dorsally, close to the 4th and 5th metacarpal base. Patients were followed for a median period of 6 years (range, 4-20 years).
Flap size ranged from 60-130 mm in length and 20-35 mm in width. This variation in flap dimensions resulted from different hand sizes, because of the various patient ages at surgery. All flaps survived, donor site healing was uneventful, and marginal flap necrosis occurred only once. Satisfactory restoration of range of motion without secondary contractures was observed. Moreover, we detected adequate progressive growth, adaptability and sensory recovery in all flaps. Over time, the flaps mostly become hairless and progressively flattened without debulking.
The importance of this flap lies in the potential for considerable tissue mobilization to cover palmar defects without sacrificing any major vascular axis. The adequate progressive growth of the flap facilitates functional hand development in children. The predictable vascular anatomy, wide range, and durable, thin, and pliable skin make the reverse neurocutaneous dorsal ulnar artery flap an appealing option for soft tissue reconstruction of the palm in children.
Therapeutic V.
摘要：
尽管手掌在严重烧伤中大部分都幸免于难，它通常在儿童中受到影响，需要彻底切除收缩性瘢痕组织以允许正常的手发育。由于替代方案仅限于手掌覆盖范围，我们主要使用反向灌注，尺背动脉神经皮皮瓣。我们在此报告我们的长期随访结果。
我们回顾了10例儿童烧伤后手掌挛缩松解术和皮瓣覆盖手术的长期结果。应用的皮瓣位于尺动脉的背侧分支的远端，并沿手和手腕的尺骨方面收获。襟翼的枢轴点位于背侧，靠近第4和第5掌骨基部。随访患者的中位时间为6年(范围，4-20年）。
襟翼尺寸在长度60-130mm和宽度20-35mm的范围内。皮瓣尺寸的这种变化是由不同的手尺寸引起的，因为手术中不同的病人年龄。所有皮瓣都存活了,供体部位的愈合是顺利的，边缘皮瓣坏死仅发生一次。观察到满意的运动范围恢复，没有继发性挛缩。此外，我们发现了足够的渐进增长，所有皮瓣的适应性和感觉恢复。随着时间的推移,瓣大多变得无毛和逐渐变平而不脱皮。
这种皮瓣的重要性在于相当大的组织动员以覆盖手掌缺损而不牺牲任何主要血管轴的潜力。皮瓣的适当进行性生长有助于儿童的功能性手发育。可预测的血管解剖结构，范围广,耐用，薄,和柔软的皮肤使反向神经皮肤尺背动脉皮瓣成为儿童手掌软组织重建的一个有吸引力的选择。
我们回顾了10例儿童烧伤后手掌挛缩松解术和皮瓣覆盖手术的长期结果。
襟翼尺寸在长度60-130mm和宽度20-35mm的范围内。
这种皮瓣的重要性在于相当大的组织动员以覆盖手掌缺损而不牺牲任何主要血管轴的潜力。
