游离腓动脉穿支皮瓣修复手部软组织缺损  

Free peroneal artery perforator flap for coverage of hand soft tissue defects

作　　者：董凯旋[1] 徐永清[1] 范新宇[1] 王毅[1] 何晓清[1] 徐龙江[2] 苏锡雄[2] 龙海[2] 许立奇[2] 陈雪松[3] 

机构地区：[1]成都军区昆明总医院附属骨科医院,全军创伤骨科研究所,653200 [2]成都军区昆明总医院超声科 [3]解放军第五十九中心医院骨科

出　　处：《中华创伤骨科杂志》2014年第10期853-857,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨游离腓动脉穿支皮瓣修复手部软组织缺损的临床疗效,方法 回顾性分析2009年12月至2013年12月使用游离腓动脉穿支皮瓣修复并获随访的22例手部软组织缺损患者资料,男15例,女7例;年龄18 ～ 57岁,平均32岁;交通伤9例,机器伤7例,重物砸伤4例,蛇咬伤2例;创面软组织缺损面积2cm×1 cm～10cm×5cm,病程1～60 d,急诊入院13例患者一期给予清创,皮肤软组织缺损二期给予皮瓣转移.所有穿支血管术前均在彩色多普勒超声（CDFI）下探查定位,有条件者联合应用计算机断层扫描血管造影技术（CTA）探查,穿支皮瓣的穿支口径为0.8～1.2 mm,末次随访时根据张浩等的疗效评价标准评定皮瓣状况并根据关节总的活动度（TAM）评分评估手部功能,结果 CDFI定位术中穿支血管位置符合率为97.5％ （39/40）,联合应用CTA定位的穿支血管术中符合率为100％,皮瓣面积为3.0cm×1.5 cm～12.0cm×7.0cm.术中供区直接缝合18例,游离植皮4例,所有患者术后随访时间为0.5 ～16.0个月（平均9.5个月）,术后所有皮瓣均存活良好,蒂部平整,外形修复满意,末次随访时根据张浩等的疗效评价标准评定皮瓣评分为9～ 10分;根据TAM评分评估手部功能：优19例,可3例,结论 游离腓动脉穿支皮瓣较薄、皮肤柔软、切取方便、血管解剖恒定、损伤小,修复手部创面外形好,有一定优势.Objective To investigate the clinical efficacy of free peroneal artery perforator flap for coverage of hand soft tissue defects.Methods From December 2009 to December 2013,22 patients with hand soft tissue defects were repaired using free peroneal artery perforator flap at our department.They were 15 males and 7 females,with an average age of 32 years （range,from 18 to 57 years）.The injury was caused by a traffic accident in 9 cases,by machinery in 7 cases,by a heavy object in 4 cases,and by a snake bite in 2 cases.The wounds ranged from 2 cm × 1 cm to 10 cm × 5 cm in area.The course of disease was from 1 to 60 days.For the 13 emergent cases,primary debridement and secondary flap transfer for skin soft tissue defects were performed.Color Doppler flow imaging was used to locate all the perforator vessels before operation,and computed tomography angiography exploration was also used if conditions permitted.The caliber diameter of the perforator artery ranged from 0.8 mm to 1.2 mm.At the last follow-up,the flap was evaluated according to the criteria proposed by Zhanghao and the hand function was assessed by total angle of motion （TAM）.Results The intraoperative coincidence rate of the perforator vessels by Color Doppler flow imaging only was 97.5％ （39/40）,and 100％ when computed tomography angiography was also used.The flap size ranged from 3.0 cm × 1.5 cm to 12.0 cm ×7.0 cm.The donor site was sutured directly in 18 cases and cured with skin grafting in 4 cases.All cases were followed up from 0.5 month to 16.0 months （mean,9.5 months）.All flaps survived well,with smooth flap pedicles and satisfactory appearance.By the Zhanghao＇s criteria,the flaps scored 9 to 10 points; by TAM,19 cases were excellent and 3 fair.Conclusion When free peroneal artery perforator flap is used for coverage of hand soft tissue defects,it exhibits advantages like thin and soft skin,easy accessibility,constant vascular anatomy,small damage,and good appearance.

关 键 词：手 外科皮瓣 软组织损伤 

分 类 号：R658[医药卫生—外科学]