Ramazan Erkin ÜNLÜ, Murat İĞDE, Mehmet Onur ÖZTÜRK, Asude KÖKSAL, Alper Burak USLU, Sinem SINGIN

Ters Akımlı Radyal Önkol Flebi ile Eldeki Doku Defektlerinin Rekonstrüksiyonu

Amaç: Radyal ön kol flebi rekonstrüktif cerrahide pek çok bölgenin rekonstrüksiyonunda da rahatça kullanılabilen fasiyokutan bir fleptir. Radyal ön kol flebi mevcut defekt alana göre dizayn edilebilmekte serbest flep olarak, ters akımlı radyal ön kol ada flebi olarak, kemik segment eklenerek osteokutanöz flep olarak veya flebe tendon eklenerek tendinokütanöz flep olarak planlanabilmektedir. Yöntemler: 2011-2014 tarihleri arasında kliniğimize başvuran 26'ı erkek 10'u kadın 36 hastaya radyal önkol flebi ile rekonstrüksiyon yapıldı. Bulgular: Travma, ilaç ektravazasyonu gibi sebeplerle ters akımlı radyal ön kol flebi ile rekonstrükte edilen 36 hastalarının defektleri el dorsumunda, 1 web aralığında ve el volarında idi. Hastaların ortalama defekt genişliği 12x6cm olarak ölçüldü. Sonuç: Tamamına ters akımlı radyal ön kol flebi ile rekonstrüksiyon planlanan tüm vakalarda estetik fonksiyonel sonuçları oldukça tatmin edici olduğu görüldü. Radyal ön kol flebi kılsız bir alan olması ve flebin ince olması özellikle elde bulky doku oluşturmaması nedeniyle iyi sonuç vermiştir. Özellikle yanık kontraktürü olan vakalarda, yanık kontraktürü sonrası rekonstrüksiyonunda fonksiyonel sonuç tatmin edici olmuştur.

Reconstruction of Hand Tissue Defects with Reverse Radial Forearm Flap

Objective: Radial forearm flap is a versatile reconstructive option which can be easily performed in reconstruction of defects in various regions of the body. Radial forearm flap can be tailored and planned according to the defect either as a free flap, a reverse flow island flap, an osteocutaneous flap with an included segment of vascularized bone or as a tendinocutaneous flap with a segment of palmaris longus tendon included in the flap. Methods: Reconstruction with a radial forearm flap is performed in 36 patients (26 males and 10 females) who admitted to our clinic between 2011 and 2014. Results: Defects caused by trauma or extravasation of the 36 patients who underwent reconstruction with a radial forearm flap were on the dorsum of the hand, in the first web interspace and on the palmar aspect of the hand. Average size of the defect was measured as 12x6 centimeters. Conclusion: All patients demonstrated satisfactory aestetic results after recontruction with a radial forearm flap. This was owing to lack of hair and pliable, thin nature of the radial forearm skin. Functional results after reconstruction were especially satisfactory in patients with burn contractures

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Charles H.Thorne .Grabb&Smith's Plastic Surgery.6th ed.Lippincott Williams &Wilkins. 2010:450-6.
Soutar DS, Scheker R, McGregor I A. The radial forearm flap: a versatile method for intra-oral reconstruction. Br J Plast Surg 1983;36:1-9
Mühlbauer W, Olbrisch R, Hemdi E, et al. Die Behandlung der Halskontraktur nach Verbrennung mit dem freien Unterarmlappen. DerChirurg 1981 ;52, 635-9.
Song R, Gao Y, Song Y et al. The forearm flap. Clin Plast Surg 1982; 9: 21-8.
Weinzweig N, Davies BW. Foot and ankle reconstruction using the radial forearm flap: a revieW of 25 cases. Plast Reconstr Surg 1998; 102: 1999- 2005.
Hallock GG, Rice DC, Keblish PA, et al.Restoration of the foot using the radial forearm flap. Ann Plast Surg 1988; 20: 14-25.
Murray RC, Gordin EA, Saigal K, Leventhal D, Krein H,Heffelfinger RN (2011) Reconstruction of the radial forearm free flap donor site using Integra artificial dermis. Microsurgery 31:104-8.
Shores JT, Hiersche M, Gabriel A, Gupta S (2012) Tendon coverage using an artificial skin substitute. J Plast Reconstr Aesthet Surg 65:1544-50.
Boahene K, Richmon J, Byrne P, Ishii L. Hinged forearmsplitthickness skin graft for radial artery fasciocutaneous flap donor site repair. Arch Facial Plast Surg 2011; 13:392-4.
Davis WJ III, Wu C, Sieber D, Vandevender DK (2011) A comparison of full and split thickness skin grafts in radial forearm donor sites. J Hand Microsurg 3:18-24.
Friedrich J, Vedder N. The use of radial forearm fascia flaps in upper extremity reconstruction. American Association for Hand Surgery Annual Meeting. Rio Grande, PR: Hand 2007; 2:51-83.
Riboh J, Nigriny J, Chong AK, Page R, Chang J. Optimization of microsurgery: improved coverage of the latissimus dorsi vascular pedicle with vascularized serratus fascia. Ann Plast Surg. 2007;58:109-11.
Page R, Chang J. Reconstruction of hand soft-tissue defects: alternatives to the radial forearm fasciocutaneous flap. J Hand Surg. 2006;31:847-56.
Javaid M, Cormack GC. Anterolateral thigh free flap for complex soft tissue hand reconstructions. J Hand Surg (Edinb, Scotl). 2003;28:21-7.
Jin YT, Guan WX, Shi TM, Quian YL, Xu LG, Chang TS. Reversed island forearm fascial flap in hand surgery. Ann Plast Surg. 1985;15:340-7.