桡动脉掌浅支复合组织皮瓣游离移植修复手指皮肤缺损  

Transfer of radial artery superficial palmar branch composite tissue flap for finger reconstruction

作　　者：赵民[1] 邵新中[2] 吴金英[3] 田德虎[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] 袁作雄[3] 

机构地区：[1]北京市顺义区医院上肢外科,101300 [2]河北医科大学第三医院手外科 [3]首都医科大学解剖教研室

出　　处：《中华手外科杂志》2014年第5期333-336,共4页Chinese Journal of Hand 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 研究以桡动脉掌浅支为蒂的腕掌侧横形微型皮瓣游离移植修复手指皮肤缺损的临床疗效.方法 2009年12月至2013年6月,采用以桡动脉掌浅支为蒂的腕掌侧横形微型皮瓣游离移植修复手指皮肤缺损26例28指,创面面积为4.0 cm×2.0 cm～2.0 cm×1.5 cm.急诊手术6例,亚急诊手术20例.结果 术后26例均获得随访,时间为8～ 12个月,平均9个月.26指皮瓣顺利存活,2指皮瓣远端部分坏死,经换药治疗后创面瘢痕愈合;供区创面均Ⅰ期愈合.术后6个月皮瓣两点分辨觉为5～10mm,平均7mm,皮瓣感觉恢复至S3.腕部供区遗留线性瘢痕,腕关节活动度无明显减小.结论 以桡动脉掌浅支为蒂的腕掌侧横形微型皮瓣供区隐蔽,手术在同一术野,质地与手指皮肤相似,可携带神经及肌腱形成复合组织,是修复手指皮肤缺损的较好方法.Objective To investigate the clinical outcomes of treating skin defects of the fingers with free transplantation of mini transverse composite tissue flap based on radial artery superficial palmar branch.Methods From December 2009 to June 2013,26 cases of skin defects of 28 fingers were treated with free mini transverse composite tissue flap based on radial artery superficial palmar branch.The size of the defects ranged from 4.0 cm× 2.0 cm to 2.0 cm× 1.5 cm.Six cases had emergency surgeries at the day of the injury,while 20 cases had sub-emergency surgeries within 3 to 5 days.Results All 26 cases were follow-up for 8 to 12 months.The average follow-up time was 9 months.The flaps in 26 fingers survived uneventfully after the operation.Partial necrosis occurred at the distal part of the flaps in 2 fingers.Secondary healing was achieved after debridement and dressing.Donor sites all healed with primary intention.There was no scar contracture.Two-point discrimination of the flaps returned to 5 to 10 mm （average,7 mm） 6 months postoperatively.Sensory recovery of the flaps was rated as S3.Only linear scar was noted at the wrist donor site.There was no limitation in range of motion of the wrist joint.Conclusion Transfer of mini transverse composite tissue flap based on radial artery superficial palmar branch is an ideal procedure to repair skin defects of the finger.The donor site is hidden.The operative field of the donor site is close to the recipient site.Texture of the flap is similar to that of the finger skin.When necessary,nerves or tendons can be included in the flap to form a composite transplant.

关 键 词：外科皮瓣 指损伤 组织移植 桡动脉掌浅支 

分 类 号：R658.2[医药卫生—外科学]