游离尺动脉腕上穿支皮瓣修复手指套脱伤  

Free transfer of the flap based on the descending branch of ulnar artery above-wrist cutaneous branch for repairing degloving injuries of fingers

作　　者：姚群[1] 芮永军[1] 寿奎水[1] 周建东[1] 赵刚[1] 

机构地区：[1]无锡市手外科医院手外科,214062

出　　处：《中华手外科杂志》2014年第6期411-413,共3页Chinese Journal of Hand Surgery

摘　　要：目的 探讨尺动脉腕上穿支皮瓣修复手指中远节套脱缺损的可行性及治疗效果.方法 2010年12月至2012年12月,切取尺动脉腕上皮支下行支皮瓣修复手指中远节套脱缺损8例共12指,采用尺动脉腕上皮支下行支皮瓣修复5指,采用尺动脉腕上皮支上行支皮瓣修复2指、采用尺动脉腕上皮支上、下行支联合皮瓣修复5指;皮瓣切取面积为5.5 cm×2.5 cm～7.0cm×4.5 cm.结果 术后1例部分坏死,经换药植皮后存活,其余皮瓣均顺利存活.3例患者在3～6个月内再次行皮瓣整形术.所有患者以问卷方式接受6～ 12个月的随访,患者对手指修复外观均表示满意,平均返回工作岗位时间为（185.2±7.7）d.按中华医学会手外科学会手功能评定试用标准评定：优4例,良3例,可1例;优良率为87.5％.术后12个月,皮瓣两点分辨觉为10～ 14 mm,平均为12 mm.结论 游离尺动脉腕上穿支皮瓣是修复手指中远端皮肤套脱伤的良好术式.Objeetive To evaluate the clinical outcomes of repairing avulsion defect of the fingers by the flap based on above-wrist contaneous branch of ulnar artery.Methods From December 2010 to December 2012,eight patients with avulsion defect of 12 fingers were treated with the above-mentioned flap.Defects in 5 fingers were repaired by the flap based on descending branch of ulnar artery above-wrist cutaneous branch,in 2 fingers by the flap based on ascending branch of ulnar artery above-wrist cutaneous branch,in 5 fingers by the flap based on both ascending and descending branches of ulnar artery above-wrist cutaneous branch.The size of the flaps ranged from 5.5 cm × 2.5 cm to 7.0 cm × 4.5 cm.Results Complete survival was achieved in all but one flap.Distal necrosis occurred in 1 flap,which was managed by debridement and skin graft.Secondary surgery to debulk the flap was carried out in 3 cases within 3 to 6 months of the first surgery.Postoperative followup ranged from 6 to 12 months.The average return-to-work time was （185.2-± 7.7） days.The outcomes were graded as excellent in 4 cases,good in 3 cases,and fair in 1 case,with an overall good and excellent rate of 87.5 ％ according to the provisional functional assessment criteria for upper limbs issued by the Hand Surgery Society of Chinese Medical Association.Two-point discrimination was 12 mm on average （range,10 to 14 mm） for the flaps at 12 months postoperatively.Conclusion The flap based on ulnar artery above-wrist contaneous branch can be used satisfactorily to repair avulsion defects of the middle and distal segment of fingers.

关 键 词：外科皮瓣 指损伤 套脱伤 尺动脉 

分 类 号：R658.2[医药卫生—外科学]