皮神经营养血管逆行皮瓣修复手部软组织缺损  

Soft tissue reconstruction in the hand using retrograde neurocutaneous flaps

作　　者：沈尊理[1] 黄一雄[1] 贾万新[1] 黄燮青[1] 王岚[1] 蔡嬿娴[1] 章开衡[1] 张兆锋[1] 沈华[1] 王永春[1] 

机构地区：[1]交通大学附属第一人民医院整形外科,上海200080

出　　处：《中华手外科杂志》2008年第1期5-7,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨以指动脉或尺动脉远端皮穿支为蒂的皮神经营养血管逆行皮瓣，修复手部软组织缺损的手术方法和临床疗效。方法根据缺损部位的不同，分别对32例手部皮肤软组织缺损进行修复，其中采用指动脉背侧穿支蒂指神经背侧支逆行皮瓣5例，拇指动脉背侧穿支蒂的拇尺背侧皮神经营养血管逆行皮瓣15例，指动脉指蹼穿支蒂的手背皮神经营养血管逆行皮瓣7例，尺动脉腕上皮穿支蒂的前臂内侧皮神经营养血管逆行皮瓣修复5例。皮瓣切取面积为1．9cm×2．0cm。7．0cm×10．0cm。在修复指腹软组织缺损的患者中，将皮瓣中的皮神经与受区掌侧指神经缝合12例。结果除1例皮瓣远端部分静脉回流障碍外，其余皮瓣均存活。术后随访时间为3个月。4年，皮瓣外形满意，手功能恢复良好。12例缝合指神经者，皮瓣两点分辨觉为10-12mm。结论穿支蒂皮神经营养血管皮瓣手术简便，血供可靠，可重建感觉功能，是修复手部创面的良好方法。Objective The aim of this study is to modify the flaps dissection and to investigate its clinical results using neurocutancous flaps based on distal perforators of digital arteries and ulnar arteries to cover soft tissue defects in the hand region. Methods Thirty-two cases were included in this series. The finger pulp soft-tissue defects were reconstructed by the dorsal digital neurocutancous flaps based on the distal dorsal perforator of the digital artery in 5 cases. The thumb pulp soft-tissue defects were reconstructed by the dorsoulnar thumb neurocutancous flaps based on the dorsoulnar perforator of the thumb digital artery in 15 cases. The middle and proximal phalangeal soft-tissue defects were covered by dorsal neurocutaneous flaps based on the digital artery perforators in the hand web space in 7 cases. The soft-tissue defects in palm and dorsum of the hand were repaired by medial antebrachial neurocutaneous flaps based on the dorsoulnar perforators of the ulnar artery in 5 cases. The dimension of the flaps ranged from 1.9 cm ×2.0cm to 7.0cm×10.0cm.In 12 cases of finger pulp coverage, nerve coaptafion was performed between the cutaneous nerve of the flap and the recipient digital nerve. Results All flaps survived except a distal venous crisis that occurred in 1 case. The follow-up duration ranged from 3 months to 4 years. All patients were satisfied with the flap appearance and the function of the hand. In the 12 cases with neurorraphy two-point discrimination of the flaps recovered in a range from 10 mm to 12mm. Conclusions It is a reliable approach for soft-tissue coverage in the hand using neurocutancous flaps based on distal perforstors of digital artery or ulnar artery. The advantages include simply procedures, reliable blood supply without sacrificing main arteries and possibilities of sensory recovery.

关 键 词：外科皮瓣 手损伤 治疗结果 皮神经 

分 类 号：R658.2[医药卫生—外科学]