改良前臂骨间背侧动脉逆行岛状皮瓣修复手背部皮肤缺损疗效观察  

EFFECTIVENESS OF IMPROVED INTEROSSEOUS DORSAL ARTERY REVERSED ISLAND FLAP FOR DORSAL SKIN AND SOFT TISSUE DEFECT OF HAND

作　　者：卜凡玉[1,2] 薛明宇[1,2] 芮永军[1,2] 顾黎明[1,2] 寿奎水[1,2] 强力[1,2] 周晓[1,2] 

机构地区：[1]无锡市第九人民医院 [2]无锡市手外科医院手外科,江苏无锡214062

出　　处：《中国修复重建外科杂志》2014年第2期237-240,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨改良前臂骨间背侧动脉逆行岛状皮瓣修复手背部皮肤软组织缺损的疗效观察。方法 2009年3月-2012年9月,采用改良前臂骨间背侧动脉逆行岛状皮瓣修复29例手背部皮肤软组织缺损患者。男17例,女12例;年龄23~71岁,平均47岁。左手12例,右手17例。急诊入院27例,其中撕脱伤11例,挤压伤9例,绞榨伤5例,交通事故伤2例;受伤至入院时间为1~7 h,平均4 h。手部外伤后瘢痕挛缩2例。软组织缺损部位:手背部21例,虎口区5例,拇指背侧区3例。软组织缺损范围4 cm×3 cm^10 cm×8 cm。11例一期修复,18例二期修复。皮瓣切取范围为5.5 cm×4.5 cm^12.0 cm×10.0 cm。供区直接拉拢缝合或植皮修复。结果术后皮瓣均顺利成活,创面Ⅰ期愈合;供区植皮均顺利成活,切口Ⅰ期愈合。术后26例获随访,随访时间3个月~3年,平均19.5个月。3例皮瓣外形臃肿,6个月后行皮瓣修整术;其余皮瓣外形较好,无臃肿。皮瓣质地均良好,腕关节功能无影响。术后3个月,根据手指关节总活动度(TAM)评定标准:获优17例,良6例,可3例。结论改良前臂骨间背侧动脉逆行岛状皮瓣具有切取简便、术后成活率高等优点,是修复手背部皮肤软组织缺损有效方法之一。Objective To discuss the effectiveness of repair dorsal skin and soft tissue defect of the hand. Methods improved interosseous dorsal artery reversed island flap to Between March 2009 and September 2012, 29 cases of dorsal skin and soft tissue defects were treated with improved interosseous dorsal artery reversed island flap. Of 29 cases, there were 17 males and 12 females, aged 23-71 years （mean, 47 years）; and the left hand was involved in 12 cases and the right hand in 17 cases. There were 11 cases of avulsion injury, 9 cases of crushing injury, 5 cases of strangulation injury, and 2 cases of traffic accident injury; the interval of injury and admission was 1-7 hours （mean, 4 hours）. Two patients had scar contracture. The locations of soft tissue defects were dorsal hands in 21 cases, first webs in 5 cases, and dorsal thumb in 3 cases. The size of soft tissue defects ranged from 4 cm×3 c m to 10 cm× 8 cm. One-stage repair was performed in 11 cases, and two-stage repair in 18 cases. The size of flaps ranged from 5.5 cm ×4.5 cm to 12.0 cm×10.0 cm. The donor sites were sutured directly or repaired by skin grafting. Results All flaps survived, and wounds healed in first stage. And the grafted skins at donor sites all survived, and incisions all healed in first stage. Twenty-six patients were followed up 3 months-3 years （mean, 19.5 months）. Bulky flap was observed in 3 cases, and defatted operation was performed after 6 months; the other flaps had good appearance and texture, and wrist function was normal. According to total angle of motion （TAM） systematic evaluation, the results were excellent in 17 cases, good in 6 cases, and fair in 3 cases at 3 months after operation. Conclusion Improved interosseous dorsal artery reversed island flap has the advantages of easy-to-obtain, simple operation, and high survival rate of flaps, so it is an effective method to repair dorsal skin and soft tissue defect of the hand.

关 键 词：改良前臂骨间背侧动脉逆行岛状皮瓣 手背部缺损 创面修复 

分 类 号：R622.1[医药卫生—整形外科]