第二跖趾关节移植联合前臂穿支皮瓣修复第一腕掌关节复合组织缺损  

Transplanting the second metatarsophalangeal joint and the forearm perforator flap for the complex soft tissue defects of the first carpometacarpal joint

作　　者：肖森[1] 刘光军 谭琪 王谦 范启申 

机构地区：[1]山东省潍坊医学院,潍坊261021 [2]解放军第八九医院创伤骨科研究所创伤三科

出　　处：《中华手外科杂志》2015年第2期116-118,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨第2跖趾关节移植联合前臂穿支皮瓣修复第1腕掌关节复合组织缺损的方法和临床效果。方法对第1腕掌关节复合组织缺损合并大面积皮肤软组织缺损的6例患者采用第2跖趾关节携带肌腱、神经及皮瓣的复合组织瓣修复，联合桡动脉穿支筋膜皮瓣及尺动脉腕上支皮瓣转移修复剩余创面。结果术后6例复合组织瓣及带蒂转移皮瓣全部存活。随访时间1～4年。重建后的腕掌关节外观良好，拇指对掌时第1腕掌关节屈伸角度、内收外展角度、旋转角度分别为（30～35）°、（18～22）°、（15～20）°，关节活动范围评价疗效为优4例、良2例。X线片示术后9～13周骨质愈合良好。皮瓣外形不臃肿，质地柔软、耐磨，感觉达S_2。S_3。结论使用第2跖趾关节移植联合前臂穿支皮瓣是修复第1腕掌关节复合组织缺损合并大面积皮肤软组织缺损的理想方法。Objective To investigate the surgical method and clinical effect of repairing the complex soft tissue defects of the first carpometacarpal joint by transplanting the second metatarsophalangeal joint and the forearm perforator flap. Methods Patients suffering from joint destruction and severe complex soft tissue defects were treated with transplanting the second metatarsophalangeal joint composite flaps with tendon, nerve, and simultaneous transplanting distal radial forearm flap based on perforators around the radial styloid process and dorso-uluar tlap ha^d on ~upracarpal perforator to repair the remainir~ defect. Results Composite flaps and transferred pedicle flaps in 6 cases all survived. After 1 to 4 years follow-up, function of carpometacarpal joint was nearly normal. X-ray showed quick healing osseous tissue after 9 to 13 weeks postoperatively. Flaps were soft, wearable and in normal shape. Sensory function in the transplant area reached S_2 to S_3. Conclusion Transplanting the second metatarsophalangeal joint and the forearm perforator flap for severe complex soft tissue defects could achieve a satisfactory effect.

关 键 词：腕掌关节 组织移植 关节移植 穿支皮瓣 

分 类 号：R622[医药卫生—整形外科]