指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣的临床应用  

Clinical application of the reverse dorsal metacarpal and digital fasciocutaneous flaps based on the dor- sal cutaneous branches of the proper digital artery

作　　者：谢松林[1] 唐举玉[1] 陶克奇[1] 吴攀峰[1] 夏小丹[1] 刘昌雄[1] 黄雄杰[1] 

机构地区：[1]南华大学附属南华医院手外科, 湖南省衡阳市 421002

出　　处：《中华显微外科杂志》2010年第6期447-449,531,共4页Chinese Journal of Microsurgery

基　　金：湖南省衡阳市科技局资助项目（2008KS006）

摘　　要：目的 探讨以指同有动脉背侧支为蒂的逆行掌指背筋膜皮瓣修复手指中、远节皮肤软组织缺损的效果。方法从2007年6月至2009年6月．应用以指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣修复25例手指中、远节皮肤软组织缺损，皮瓣旋转点位于手指近节中点或近节远段。结果 24例皮瓣完全成活．1例皮瓣远端少部分表皮层坏死。随访病例20例，随访12。18个月。6例皮瓣蒂部局部臃肿需要二期修薄，其余皮瓣血运良好，耐寒，皮瓣薄而质地柔软，外观色泽良好，皮瓣供区无伸肌腱粘连和指蹼挛缩：5例吻合神经的皮瓣两点分辨觉6～10mm，15例未吻合神经的皮瓣两点分辨觉8—14mm。结论 以指同有动脉背侧支为蒂的逆行掌指背筋膜皮瓣血运可靠．旋转弧长．操作简单，皮瓣更接近创面．对皮瓣供区损伤更小，可以吻合皮神经重建皮瓣感觉，是～种修复手指中、远节软组织缺损的理想方法。Objective To investigate the effect of repairing soft tissue defects in the middle and distal phalanx with the reverse dorsal metacarpal and digital fasciocutaneous flap based on the dorsal cutaneous branches of the proper digital artey,. Methods Twenty-five fingers with soft tissue defects in the middle and distal phalanx were repaired by the reverse dorsal metacarpal and digital faseiocutaneous flaps based on the dorsal cutaneous branches of the proper digital artery from June 2007 to June 2009. Their pivot points were located at the midpoint or distal segment of proximal phalanx. Results Among ：25 flaps, 24 survived completely, but cuticular layer in the distal part of one flap was partially necrotic. Twenty flaps were followed up fi＇om 12 to 18 months after operation. All flaps were characterized by rich blood supply, cold-resistance, suitable thickness, soft texture and good colour, except that 6 flaps required a secondary operation because of their fat and elumsy pedicel. There was no adhesion of extensor tendon and contraction of interdigital web in the donor sites. Two-point discriminations of anastomosing cutaneous nerve ranged from 6 mm to 10 mm in 5 of the 20 flaps, and 8 mm to 14 mm in the other 15 flaps. Conclusion The dorsal metacarpal and digital faseiocutaneous flap based on the dorsal cutaneous branches of the proper digital artery is an ideal option for repairing soft tissue defects of middle and distal phalanx because of its advantages of easy and secure dissection, reliable blood supply, longer arch of rotation, being closer to the raw surface of finger, less injury to the donor site, good appearance, avoidance of sacrificing major arteries ,and high probability of reconstructing flap sensation by anastomosing cutaneous nerve.

关 键 词：指 掌指背筋膜皮瓣 指固有动脉 逆行皮瓣 显微外科 

分 类 号：R686[医药卫生—骨科学]