指固有动脉近侧穿支蒂掌背皮瓣的解剖与临床应用  

The dissection and clinical application of the dorsal metacarpal flap with the arteria digitalis proximal dorsal perforating branches

作　　者：唐修俊[1] 魏在荣[1] 周信荣[1] 吴必华[1] 孙广峰[1] 韩文杰[1] 王达利[1] 

机构地区：[1]遵义医学院附属医院烧伤整形外科,贵州遵义563099

出　　处：《遵义医学院学报》2013年第1期44-47,51,共5页Journal of Zunyi Medical University

基　　金：贵州省科技厅社发基金项目(NO:黔科合SY字[2010]3060)

摘　　要：目的探讨指固有动脉近侧穿支蒂掌背皮瓣切取及修复手指创面的可行性。方法取20条经动脉灌注红色乳胶的成人上肢尸体标本,解剖观察指固有动脉近侧穿支、指蹼动脉、掌背动脉穿支等血管走行、吻合。据此设计指固有动脉近侧穿支蒂掌背皮瓣。18例手指创面采用指固有动脉近侧穿支蒂掌背皮瓣修复。男12例,女6例,年龄6～60岁。创面范围约4.0cm×2.0cm～5.0cm×2.0cm,皮瓣范围约5.0cm×2.2cm～6.5cm×2.2cm。皮瓣供区采用游离植皮覆盖或直接缝合。结果术后皮瓣及植皮均顺利成活。患者均获随访,随访7～18个月,平均12个月。皮瓣外形良好。手指伸屈无功能障碍,皮瓣两点辨别觉8～9mm。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手指总主动活动度,获优18例。结论指动脉近侧穿支与指蹼动脉、掌背动脉穿支等血管的分支有较恒定的吻合,指动脉近侧穿支蒂掌背皮瓣可修复手指较大创面,手术简单、血供可靠。Objective Discussing the feasibility of repairing the finger wound using the dorsal metacar- pal flap with the arteria digitalis proximal dorsal perforating branches. Methods The artery of hand from 20 adult upper limb specimens were filled in red latex. To observe the anastomosis of the arteria digitalis proximal dorsal perforating branches and fingerweb artery and dorsal metacarpal artery. To design dorsal metacarpal flap with the arteria digitalis proximal dorsal perforating branches according to the blood ves- sels relationship. 18 patients with the wounds on fingers were treated in the dorsal metacarpal flaps. Of these ,6 was female and 12 were males. With an age range from 6 to 60 years. The area of wounds ： 4.0 cm x 2.0 cm - 5.0 cm x 2. 0 cm. The area of flaps ： 5.0 cm x 2. 2 cm - 6. 5 cm x 2. 2 cm. The donor site were covered by skin graft or directly sutured. Results All of the flaps and skin grafts were successfully survived for the I stage. All cases were followed up 7 - 18months, averaged 12 months. There were good appearance of flaps. The fingers hadn＇ t dysfunction. The two point discrimination of the flaps were 8 - 9mm. According to the part function evaluation trial - use standard of upper limb of Hand Surgery Asso- ciation Society of Chinese Medical Association Society,the total active movement （TAM） ： 18 excellent cases. Conclusion There are constant artery anastomosis between arteria digitalis proximal dorsal perfora- ting branches and fingerweb artery and dorsal metacarpal artery. The flaps with the arteria digitalis proxi- mal dorsal perforating branches can repair the wounds on fingers. The blood supply of the flaps was relia- ble and the operation was simple.

关 键 词：外科皮瓣 手 创面修复 

分 类 号：R622[医药卫生—整形外科]