不同远端蒂逆行掌背皮瓣修复手指软组织缺损  

Different distally-based dorsal metacarpal flaps for repair of soft tissue defects of the finger

作　　者：姚群[1] 芮永军[1] 许亚军[1] 周晓[1] 陈学明[1] 

机构地区：[1]无锡市手外科医院手外科,214062

出　　处：《中华手外科杂志》2012年第3期140-142,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨不同远端蒂掌背皮瓣修复手指软组织缺损的方法和疗效。方法2008年6月至2009年5月，利用远端蒂逆行掌背皮瓣修复手指软组织缺损37例共45指，其中29指以指蹼处穿支为蒂逆行掌背皮瓣修复，16指以指背动脉背侧支为蒂的掌背皮瓣修复。结果41块皮瓣顺利存活，4块皮瓣远端轻微血运障碍，经拆除少部分皮瓣缝线后逐渐愈合。术后37例获得随访时间为10～24个月，皮瓣外观满意，患指功能良好。按中华医学会手外科学会上肢部分功能评定试用标准评定：优30例，良5例，可2例；优良率为94．6％。结论掌背皮瓣存在掌背动脉远端穿支和掌背皮神经营养血管双重供血系统，可灵活选择不同的远端蒂，有效满足手指不同创面的修复需要。Objective To explore the application of dorsal metacarpal flaps based on different distal pedieles for repair of soft tissue defects of the fingers. Methods From June 2008 to May 2009, soft tissue defects of 45 fingers in 37 patients were repaired by distally-based retrograde dorsal metacarpal flaps. Among these dorsal metacarpal flaps, 29 were pedicled on the finger web perforator, and 16 were pedicled on the dorsal perforator of the digital artery. Results Forty-one flaps survived uneventfully. Minor blood circulation compromise was noted in 4 flaps. The situation was salvaged by removing a couple of stitches at the distal portion of the flaps. These flaps survived and healed as well. Postoperative follow-up was sufficient in 37 cases, ranging from 10 to 24 months. All repaired fingers had satisfactory appearance and good function. The outcomes were graded as excellent in 30 cases,good in 5 cases,fair in 2 cases,and the good and excellent rate of finger function reached 94.6% according to the provisional functional assessment criterion for upper limbs issued by the Hand Society of Chinese Medical Association. Conclusion The bloed circulation of dorsal metacarpal flap is commonly supplied by dorsal metacarpal artery perforators and dorsal metacarpal cutaneous nerve nutrient vessels, which anastomose widely around the metaearpophalangeal joint and the proximal phalanx. This provides the options of different distal pedieles which can be selected for flap design to effectively meet the needs of wound coverage of the fingers.

关 键 词：岛状皮瓣 指损伤 外科手术 

分 类 号：R658.2[医药卫生—外科学]