掌背动脉穿支蒂逆行筋膜皮瓣与蒂部微型瓣的设计与应用  

Design and application of mini-flap at the pedicle of dorsal metacarpal perforator reversed fasciocutaneous flap

作　　者：王培吉[1] 赵家举[1] 张勇[1] 

机构地区：[1]苏州大学附属第二医院手足外科,苏州215004

出　　处：《中华手外科杂志》2013年第4期212-214,共3页Chinese Journal of Hand Surgery

基　　金：江苏省苏州市科技发展计划资助项目（SYS201230）

摘　　要：目的探讨掌背动脉穿支蒂逆行筋膜皮瓣与蒂部设计微型瓣的方法及其临床疗效。方法2005年10月至2011年8月，对17例手指皮肤软组织缺损伴指骨或肌腱外露患者，采用掌背动脉穿支蒂逆行筋膜皮瓣进行修复，皮瓣切取面积为7．5cm×3．0cm-4．0cm×2．0cm。术中在掌背动脉穿支蒂逆行筋膜皮瓣蒂部设计微型瓣，微型瓣呈圆形或椭圆形，面积为2．0cm×1．5cm～1．0cm×1．0cm。结果术后16例皮瓣全部存活；1例第2掌背动脉皮瓣出现远端边缘坏死，经换药后愈合。随访时间为6—28个月，平均14．6个月。皮瓣质地柔软，外形良好。皮瓣两点分辨觉为5～9mm，平均7．6mm。手指功能恢复良好。结论在掌背动脉穿支蒂逆行筋膜皮瓣蒂部设计应用微型瓣可有效地防止蒂部血管受压或血管网破坏而影响皮瓣的血运，是一种预防掌背动脉皮瓣术后血供障碍的可靠方法。Objective To explore the feasibility of designing and applying a mini-flap at the pedicle of dorsal metacarpal perforator fasciocutaneous flap and evaluate the clinical results. Methods From October 2006 to August 2011, 17 patients with soft tissue defects of the finger accompanied with exposure of the phalanx or tendons were treated using dorsal metacarpal perforator reversed fasciocutaneous flaps. The size of the flaps ranged from 7.5 cm× 3.0 cm to 4.0 cm × 2.0 cm. A mini-flap, oval or round, was designed at the pedicle of the dorsal metacarpal artery perforator flap. The area of the mini-flap was between 2.0 cm× 1.5 cm to 1.0 cm× 1.0 cm. Results Complete flap survival was seen in 16 cases. Distal marginal flap necrosis occurred in one case which healed after changing the dressing. The mean follow-up time was 14.6 months （range, 6 to 28 months）. The flaps were supple with good appearance. Two-point discrimination of the flaps ranged from 5 to 9 mm, with an average of 7.6 ram. There was good recovery of finger function. Conclusion A mini-flap designed at the pedicle of the dorsal metacarpal artery perforator fasciocutaneous flap can effectively prevent vessel compressing at the pedicle or vascular network compromise. It is a reliable method to prevent postoperative blood supply problems in dorsal metacarpal artery fasciocutaneous flap transfers.

关 键 词：外科皮瓣 指损伤 软组织损伤 穿支皮瓣 

分 类 号：R658.2[医药卫生—外科学]