改良指背筋膜蒂逆行岛状皮瓣修复指端皮肤缺损  

Repairing fingertip defects by the modified retrograde dorsal fasciocutaneous flap

作　　者：余少校[1] 张振伟[1] 杨诚[1] 李征[1] 白印伟[1] 陈国荣[1] 周望高[1] 熊懿[1] 

机构地区：[1]广州医科大学附属深圳沙井医院手外科,广东深圳518104

出　　处：《实用手外科杂志》2013年第3期331-334,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨改良指背筋膜蒂逆行岛状皮瓣修复指端皮肤缺损的疗效及临床分析。方法切取指背筋膜蒂皮瓣时，皮瓣近端预留一条长1～2cm指背静脉，皮瓣切取后，松开止血带，温盐水复温，皮瓣蒂部局部应用罂粟碱解痉，观察并判断皮瓣供血与回流情况。若皮瓣出现血供不足，通过皮瓣内预留指背静脉与指动脉断端吻合，形成静脉动脉化皮瓣（10例）；若皮瓣出现静脉回流障碍，则将皮瓣内指背静脉与受区皮下静脉吻合，改善其回流（12例）；若皮瓣供血与回流基本平衡，则无需进行血管吻合（13例）。结果临床应用改良的指背筋膜蒂皮瓣修复指端皮肤缺损35例，皮瓣面积：1．2cm×1．6cm-2．7cm×3．2cm，其中辅助吻合预留血管22例，辅助血管吻合率63％，皮瓣全部成活。术后72h除静脉动脉化皮瓣有3例出现张力性水疱外．其余病例伤口均一期愈合，皮瓣供区植皮成活。术后随访6～18个月，平均9个月，手指功能与外观均满意，皮瓣质地良好，指端饱满，无触压痛。结论传统指背筋膜蒂逆行岛状皮瓣经选择性辅助吻合血管处理，其成活率和成活质量均有明显改善。Objective To study the efficacy and clinical analysis of repairing fingertip defects by the modified retrograde dorsal fasciocutaneous flap. Methods The dorsal vein with the length of 1.0-2.0cm was reserved from the proximal flap when the dorsal fasciocutaneous flap was cut. After the cutting of the flap, loosen the tourniquet, salt water temperature, local application of papaverine for spasmolysis, the flap blood supply and reflux were observed and judged. If the flap blood supply was insufficient, the venous flap would be formatted by the anastomosis of dorsal vein stump with arterial broken end of flap （10 cases）. If the flap vein-reflux disorders occured, the reflux would be improved by the anastomosis of the flap dorsal vein with subcutaneous vein of the receive area （12 cases）. If the flap blood supply and reflux was balanced basically, the vascular anastomosis would be not necessary （13 cases）. Results The flap was used to repair skin defects of distal fingers in 35 cases, whose size was 1.2 cm×1.6 cm-2.7 cm×3.2 cm, and the reserved vascular of 22 cases were done with assisted anastomosis, the rate was 63%. All flaps survived, except with 3 cases of venous arterialized flap which had tension vesicle 72 h postoperatively, the remaining cases were primary healing, and the skin graft survived in the donor site. During the foUow-up of 6-18 months and the mean period of 9 months, the finger function and appearance were both satisfied with good texture, full fingertip, but no touch tenderness. Conclusion Through disposing of assisted vascular anastomosis selectively, the survival rate and survival quality of the traditional retrograde dorsal fasciocutaneous flap has improved significantly.

关 键 词：筋膜蒂皮瓣 辅助血管吻合 修复 

分 类 号：R658.2[医药卫生—外科学]