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目的 探讨组合穿支皮瓣设计在上臂外侧皮瓣中的应用技巧以及临床修复上肢较大软组织创面的应用前景.方法 自2011年3月至2014年7月,6例较大面积(10 cm×8 cm～ 11 cm×14 cm)的上肢皮肤软组织缺损患者接受了这一新的术式.通过组合穿支皮瓣设计,将一个宽度较大的缺损面积分割为两个宽度较小的上臂外侧穿支皮瓣,通过分叶皮瓣的重新组合,覆盖受区缺损,并实现供区皮肤直接缝合.其中5例患者远端皮瓣的设计超过了肱骨外上髁,血供来自桡侧副动脉终末支在肘关节外侧形成的血管网.结果 6例皮瓣均顺利存活.术后随访3～ 12个月,皮瓣外观及弹性良好,供区仅留一条线性瘢痕.结论 基于上臂外侧穿支皮瓣的组合穿支设计可用于修复较大创面的皮肤缺损.这一新的理念扩展了上臂外侧皮瓣的临床应用范围,且临床效果满意.“,”Objective To explore the surgical techniques in designing combined perforator flaps of the lateral arm and the prospect of using this flap to repair large defects of the upper extremity.Methods From March 2011 to July 2014, 6 cases of large skin defects (10 cm× 8 cm to 11 cm× 14 cm) of the upper extremity were treated with this new procedure.According to the width of the large defect, two narrower lateral arm perforator flaps based on one vascular pedicle were designed to form a double lobular combined flap for coverage of the large defect.The donor sites were closed directly.The distal flap in 5 cases derived its blood supply from the vascular network around the elbow formed by lateral radial collateral artery terminal branch, since the extent of the flap went beyond the lateral epicondyle.Results All 6 combined flaps survived uneventfully.Postoperative follow-up ranged from 3 to 12 months.The appearance and texture of the flaps were good.Only linear scars were seen at the donor sites.All patients were satisfied with their clinical outcomes.Conclusion Combined perforator flaps of the lateral arm can effectively cover large defects of the upper extremity.This new flap design concept expands the indications of lateral arm perforator flap with satisfactory outcomes.