第一掌背动脉蒂网状供血分叶皮瓣修复拇示指不规则创面  

REPAIR OF IRREGULAR WOUNDS ON THUMBS AND INDEX FINGERS WITH FIRST DORSAL METACARPAL ARTERY-BASED PEDICLE DICTYO-PATTERN SUBLOBE FLAPS

作　　者：魏在荣[1] 王甜甜[1] 税兰[1] 孙广峰[1] 王达利[1] 王玉明[1] 

机构地区：[1]遵义医学院附属医院整形科,贵州遵义563003

出　　处：《中国修复重建外科杂志》2010年第1期46-49,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨第1掌背动脉蒂网状供血分叶皮瓣修复拇、示指不规则创面的手术方法及近期疗效。方法2006年12月-2009年3月,收治15例拇、示指不规则创面。男11例,女4例;年龄18～48岁,平均31岁。烧伤后增生性瘢痕挛缩切除术后6例,病程2～25年,平均7.5年;机器绞伤9例,病程14～30d,平均20d。拇指8例,创面均位于掌侧,呈菱形3例,C形1例,不规则4例;创面范围为4.5cm×3.0cm～5.5cm×4.5cm,采用顺行第1掌背动脉蒂网状供血分叶皮瓣修复,皮瓣范围5cm×3cm～6cm×5cm。示指7例,创面均位于背侧,2个创面3例,不规则创面4例;创面范围为1.0cm×0.5cm～2.2cm×2.0cm,采用逆行第1掌背动脉蒂网状供血分叶皮瓣修复,皮瓣范围1.2cm×0.5cm～3.0cm×2.2cm。供区采用游离植皮或直接缝合。结果术后皮瓣及植皮均顺利成活,供、受区切口均Ⅰ期愈合。患者均获随访,随访时间6～12个月,平均9个月。皮瓣外形良好。顺行皮瓣两点辨别觉5～7mm,逆行皮瓣9～10mm。拇指恢复对指、对掌功能,示指伸屈功能无障碍。根据中华医学会手外科学会上肢部分功能评定试用标准评定拇、示指总主动活动度,获优14例,良1例。供区直接缝合者遗留一线状瘢痕,虎口功能无明显异常。结论第1掌背动脉蒂网状供血分叶皮瓣修复拇、示指不规则创面具有手术操作简便、血供可靠的优点。Objective To explore the effect of the first dorsal metacarpal artery-based pedicle dictyo-pattern sublobe flaps in repairing irregular wounds on thumbs and index fingers.Methods From December 2006 to March 2009,15 patients with irregular wounds on thumbs and index fingers were treated,including 11 males and 4 femals,with an average age of 31 years（range,18-48 years）.Of them,6 cases of hyperplastic scar of postburn had a 2-25 years course of disease（7.5 years on average）and 9 cases of machine injury had a 14-30 days course of disease（20 days on average）.In 8 thumb wounds on palmaris, there were 3 cases of rhomboid wounds,1 case of C-shape wound,and 4 cases of irregular wounds;the area of wounds ranged from 4.5 cm×3.0 cm to 5.5 cm×4.5 cm and wounds were treated by the first dorsal metacarpal artery-based proximate pedicle dictyo-pattern sublobe flaps（5 cm×3 cm to 6 cm×5 cm）.In 7 index fingers wounds on dorsi-fingers,there were 3 cases of 2-wounds,4 cases of irregular wounds;the area of wounds ranged from 1.0 cm×0.5 cm to 2.2 cm×2.0 cm and wounds were treated by the first dorsal metacarpal artery-based distal pedicle dictyo-pattern sublobe flaps（1.2 cm×0.5 cm to 3.0 cm× 2.2 cm）.The donor sites were covered with skin grafts or sutured directly.Results All of the flaps survived completely,the wound of recipient site healed at stage I.The free skin graft on donor site survived completely,the wound of donor site healed at stage I.All cases were followed up for 6-12 months（9 months on average）.There was good appearance of flaps.The two point discrimination was 5-7 mm for the proximate pedicle flaps and 9-10 mm for the distal pedicle flaps.The thumbs had digital opposition,opposition function,the index fingers had no dysfunction.According to Hand Surgery Association Society of Chinese Medical Association Society standard for the part function evaluation trial-use of upper limb,the results of the total active movement were excellent in 14 cases,and good in 1 case.The line-scar was existed a

关 键 词：第1掌背动脉蒂网状供血分叶皮瓣 拇指 示指 不规则创面 修复 

分 类 号：R658.2[医药卫生—外科学]