前臂桡动脉腕上穿支链状供血皮瓣修复手腕部创面的临床应用  

CLINICAL APPLICATION OF REPAIRING WOUND IN WRIST WITH FLAP SUPPORTED BY PERFORATING BRANCH OF FOREARM RADIAL ARTERY AND CATENA-FORM BLOOD VESSEL

作　　者：胡鹏[1] 唐修俊[1] 魏在荣[1] 王达利[1] 孙广峰[1] 王宝云[1] 昝钦[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563000

出　　处：《中国修复重建外科杂志》2014年第4期491-494,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨前臂桡动脉腕上穿支链状供血皮瓣修复手腕部创面的疗效。方法 2010年3月-2013年3月,应用前臂桡动脉腕上穿支链状供血皮瓣修复24例手腕部创面患者。男15例,女9例;年龄19~54岁,平均37岁。致伤原因:外伤22例,其中机器绞榨伤9例,交通事故伤5例,重物压伤5例,锐器刺伤1例,电击伤2例;病程2~20 d,平均11 d。前臂恶性肿瘤切除后2例,其中右前臂黏液脂肪肉瘤1例,左前臂鳞状细胞癌1例;病程7 d及3个月。创面均伴骨及肌腱外露。皮肤软组织缺损范围为4.5 cm×4.0 cm^10.0 cm×7.5 cm。皮瓣切取范围为6.0 cm×4.0 cm^20.0 cm×8.5 cm。供区皮下游离后直接缝合或游离植皮修复。结果术后1例皮瓣远端边缘发生部分坏死,经换药后愈合;其余皮瓣及植皮均成活,创面均Ⅰ期愈合。患者均获随访,随访时间6~36个月,平均20个月。皮瓣色泽、质地好。术后6个月皮瓣均恢复保护性感觉,两点辨别觉11~14 mm,平均12 mm。皮瓣无溃疡发生。末次随访时,按照中华医学会手外科学会上肢部分功能评定试用标准评定:获优19例,良4例,可1例。结论前臂桡动脉腕上穿支链状供血皮瓣切取时不损伤桡动脉,对于尺、桡动脉腕部吻合网损伤者也可应用;手术操作简便,术后皮瓣外形可,是修复手腕部创面的一种较好方法。Objective To explore the clinical application of the flap supported by perforating branch of the radial artery superior wrist catena-form blood vessel in repairing hand and wrist wound. Methods Between March 2010 and March 2013, 24 cases of severe wounds in wrist were repaired with the flap supported by perforating branch of forearm radial artery and catena-form blood vessel. There were 15 males and 9 females, aged 19-54 years （mean, 37 years）. In 22 patients with trauma, there were 9 cases of machine injury, 5 cases of traffic accident injury, 5 cases of crash injury of heavy objects, 1 case of sharp instrument injury, and 2 cases of electrical injury, with a mean disease duration of 11 days （range, 2-20 days）. In 2 patients with tumor excision wound, there were 1 case of right forearm liposarcoma and 1 case of left forearm squamous-cell carcinoma, with the disease duration of 7 days and 3 months, respectively. All cases complicated by bone and tendon exposure. The size of defect was 4.5 cm x 4.0 cm to 10.0 cmx 7.5 cm, and the size of the flap was 6.0 cmx 4.0 cm to 20.0 cm ~ 8.5 cm. The donor site was directly sutured or repaired by skin graft. Results Partial flap necrosis occurred in 1 case, and was cured after dressing change; the other flaps survived, and primary healing of incision was obtained. The patients were followed up 6-36 months （mean, 20 months）. The flap featured good color and texture, and also recovered protective sensation at 6 months after operation, with a mean two-point discrimination of 12 mm （range, 11-14 ram）. No ulcers of the flap was observed. At last follow-up, according to Hand Surgery Society of Chinese Medical Association for functional evaluation of upper limb, the function was rated as excellent in 19 cases, good in 4 cases, and fair in 1 case. Conclusion The flap supported by perforating branch of forearm radial artery and catena-form blood vessel can be used to repair wound in wrist, which has no injury to the radial artery, and it also could be used for the pati

关 键 词：穿支皮瓣 桡动脉腕上穿支 链状供血 创面修复 

分 类 号：R658.2[医药卫生—外科学]