跖内侧皮瓣联合肋骨移植修复多手指末节骨与软组织缺损  

Repair of soft tissue and bone defects at the distal phalanx with rib graft and the medial plantar flap

作　　者：张功林[1] 章鸣[1] 王干生[1] 郁辉[1] 陈剑锋[1] 

机构地区：[1]浙江省温岭市台州骨伤医院骨科,317500

出　　处：《中华创伤骨科杂志》2008年第7期627-630,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的总结跖内侧皮瓣联合肋骨移植修复多手指末节掌侧骨与软组织缺损的临床应用结果。方法2004年2月至2006年7月，应用吻合血管的跖内侧皮瓣联合肋骨移植修复5例（男4例，女1例）手指末节掌侧骨与软组织缺损，年龄19～43岁（平均31岁）。其中，双指损伤3例，3指损伤2例。皮瓣血管蒂与受区的血管行端端吻合，供区创面行中厚网状游离植皮修复。结果1例术后供区发生表浅感染，经更换敷料逐渐自行愈合。皮瓣全部成活，随访10—28个月（平均19个月），供区与受区外形较好，手指感觉恢复，两点分辨觉5～14mm（平均8mm）。结论跖内侧皮瓣以跖内侧动脉为血供，血运丰富、血管解剖恒定、血管蒂长以及切取容易，联合肋骨移植很适宜修复多手指末节掌侧骨与软组织缺损。Objective To summarize our clinical applications of rib graft and the medial plantar flaps to repair soft tissue and bone defects at the distal phalanx. Methods Five patients （4 males, 1 female） with soft tissue and bone defects on the palmar surface of the distal phalanx underwent microvaseular reconstruction with the rib graft and the medial plantar flap. Their ages ranged from 19 to 43 （mean, 31） years. Of them, 3 cases had defects at 2 fingers and the other 2 had defects at 3 fingers. The wound of donor site was closed by a meshed split-thickness skin graft. The vascular pedieles of the flaps were anastomosed end-to-end to the recipient site vessels. Results One case sustained superficial postoperative infection at the donor site and the wound healed gradually by daily dressing. The flaps survived completely without major complications. Follow-up of 10 to 28 （mean, 19） months revealed satisfactory clinical results. Good appearance was obtained at the donor and recipient sites. Durable, sensate coverage of the defects was achieved in all patients and their 2-point discrimination was 5 to 14 （mean, 8） mm. There was no remarkable donor site morbidity. Conclusions Nourished by the medial plantar artery, the medial plantar flap has a constant and rich vascular anatomy. Its long vascular pedicle makes the flap dissection easy. The technique of rib graft and the medial plantar flap transplant is suitable for repair of the soft tissue and bone defects on the palmar surface of the distal fingers.

关 键 词：指损伤 外科皮瓣 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]