以第二掌背动脉近、远端为双轴点的掌背部岛状皮瓣  

The second dorsal metacarpal artery island flap with proximal and distal pivot points

作　　者：姚建民[1] 赵正[2] 李建兵[1] 吴守成[1] 沈向前[1] 

机构地区：[1]杭州市整形医院,浙江310014 [2]杭州市第一人民医院整形外科

出　　处：《中华手外科杂志》2000年第1期37-39,共3页Chinese Journal of Hand Surgery

摘　　要：目的　介绍一种改良的第二掌背动脉皮瓣的手术方法和适应证。方法　将以第二掌背动脉起点为轴点的中指背岛状皮瓣 ,改良为带有近、远端二个轴点的第二掌背部岛状皮瓣。远端轴点旋转180°即可使覆盖、斜跨于示指伸肌腱浅面掌背部皮瓣的近端翻至远端 ,延长了该皮瓣自第二掌背动脉起始部至皮瓣远端的距离 ;通过近端轴点的旋转使皮瓣能横向转移至拇指 ,经皮下隧道达到拇指指端。临床修复 7例拇指指端创面 ,皮瓣面积 1cm× 3cm～ 2cm× 5cm ,血管蒂长 6～ 7cm。结果　 7例皮瓣全部成活 ,修复的拇指外形满意、指关节伸屈同健侧。结论　该皮瓣的最佳适应证是修复拇指指端创面。Objective To introduce the surgical techniques and indications of a modified second dorsal metacarpal artery flap.Methods The second dorsal metacarpal artery flap pivoted at the origin of the artery was converted to one with double pivot points.The proximal pivot point was the origin of the second dorsal metacarpal artery (SDMA).The entry point of the recurrent cutaneous branch into the flap marked the distal pivot point.The flap was designed over the second metacarpal and dissected superficial to the paratenon of the extensor tendons to the index finger.The dissection of the vascular pedicle was continued proximally under SDMA up to its origin.The flap was rotated for 180 degrees at the distal pivot point so that the proximal part of the flap became the distal end, and the rotation arc was lengthened to include both the length of the vascular pedicle and the length of the flap.When rotated at the proximal pivot point,the flap can be tunnel subcutaneously and transferred to distal part of the thumb.This flap was used for coverage of distal defects of the thumb in 7 cases.The size of the flaps was 1 cm × 3 cm to 2 cm × 5 cm,while the length of the vascular pedicle was 6 to 7cm. Results The 7 flaps survived uneventfully.The reconstructed thumbs regained satisfactory appearance and normal range of motion of the interphalangeal joints. Conclusion The second dorsal metacarpal artery flap with double pivot points is advocated for repair of distal defects of the thumb.

关 键 词：外科皮瓣 指损伤 动脉 掌背部岛状皮瓣 

分 类 号：R622.1[医药卫生—整形外科]