腕部掌侧桡动脉掌浅支横行微型皮瓣游离移植修复手指皮肤缺损  

CLINICAL APPLICATION OF MICRO TRANSVERSE FLAP PEDICLED WITH SUPERFICIAL PALMAR BRANCH OF RADIAL ARTERY FROM PALMAR WRIST TO REPAIR SKIN DEFECT OF FINGER

作　　者：赵民[1] 田德虎[2] 邵新中[2] 李大村[1] 刘井达[1] 赵亮[1] 李海雷[1] 王晓磊[1] 张文桐[1] 李建锋[1] 

机构地区：[1]中国医科大学北京市顺义医院上肢外科,北京101300 [2]河北医科大学第三医院手外科

出　　处：《中国修复重建外科杂志》2013年第12期1475-1479,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：首都卫生发展科研专项基金资助项目(2011-7081-01)~~

摘　　要：目的探讨以桡动脉掌浅支为蒂的腕部掌侧横行微型皮瓣游离移植修复手指皮肤缺损的疗效。方法2011年12月-2013年2月,收治手指皮肤缺损26例(26指)。男20例,女6例;年龄20~56岁,平均31.5岁。致伤原因:切割伤20例,挤压伤6例。受伤至入院时间为1~5 h,平均2 h。损伤指别:拇指6例,示指6例,中指6例,环指4例,小指4例。损伤部位:指背侧6例,指侧方6例,指端掌侧14例;手指近节4例,中节8例,末节14例。创面范围为2.0 cm×1.5 cm^4.0 cm×2.0 cm。采用大小为2.5 cm×2.0 cm^4.5 cm×2.5 cm以桡动脉掌浅支为蒂的腕部掌侧横行微型皮瓣游离移植修复。供区直接拉拢缝合。结果术后1例皮瓣远端部分坏死,经换药治疗后创面瘢痕愈合;余25例皮瓣全部成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合。26例均获随访,随访时间6~12个月,平均10个月。皮瓣外形满意,质地柔软。术后6个月皮瓣两点辨别觉为5~8 mm,平均6.8 mm。供区无瘢痕挛缩,腕关节屈、伸活动无明显受限。结论以桡动脉掌浅支为蒂的腕部掌侧横行微型皮瓣游离移植修复手指皮肤缺损,具有供区隐蔽、皮瓣与手指皮肤相似度高、可携带神经及肌腱、手术在同一术野完成等优点。Objective To investigate the clinical application of micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist to repair skin defect of finger. Methods Twenty-six cases （26 fingers） with skin defect of finger were repaired with micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist between December 2011 and February 2013. There were 20 males and 6 females with the average age of 31.5 years （range, 20-56 years）. The causes of injury included cutting injury in 20 cases and crushing injury in 6 cases. The time from injury to admission was 1-5 hours with an average of 2 hours. Injured fingers included thumb in 6 cases, index finger in 6 cases, middle finger in 6 cases, ring finger in 4 cases, and little finger in 4 cases; the locations were the dorsal side of the finger in 6 cases, lateral side in 6 cases, and the volar of the finger tip in 14 cases; there were 4 cases on the proximal phalangeal skin, 8 cases on the middle phalangeal skin, and 14 cases on the distal phalangeal skin. The defect area ranged from 2.0 cm x 1.5 cm to 4.0 cm x 2.0 cm, and the flap area ranged from 2.5 cm × 2.0 cm to 4.5 cm× 2.5 cm. All the donor sites were directly sutured. Results The flaps of 25 cases survived well after operation, and wound healed by first intention; 1 case had partial necrosis and the wound had a scar healing by changing dressing. All cases were followed up 6-12 months （mean, 10 months）. The color and appearance of the flaps were satisfactory with tender texture. The two-point discrimination of the flap was 5-8 mm （mean, 6.8 ram）. The donor sites healed primarily without scar contracture and limitation of wrist flexion or extension. Condusion The micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist is a good option to repair skin defect of finger. It has the advantages of hidden donor site, the same operative field, great comparability of flap and finger skin, and it can be used

关 键 词：腕部掌侧横行微型皮瓣 桡动脉掌浅支 手指 创面修复 

分 类 号：R658.2[医药卫生—外科学]