旋股外侧动脉降支血流桥接皮瓣重建手掌毁损伤创面  

Reconstruction of Destructive Wound of the Palm with Flow-through Flaps Based on the Descending Branch of the Lateral Circumflex Femoral Artery

作　　者：李涛[1] 陈振兵[1] 丛晓斌[1] 艾方兴[1] 周攀[1] 洪光祥[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院手外科,武汉430022

出　　处：《华中科技大学学报（医学版）》2015年第2期206-208,212,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：湖北省自然科学基金资助项目(No.2013CFC040)

摘　　要：目的探讨股前外侧动脉穿支皮瓣以"血流桥接"术式移植修复手掌毁损伤创面的临床效果。方法 2011年7月至2012年5月,对7例手掌毁损伤创面,采用旋股外侧动脉降支血流桥接皮瓣移植,修复创面并桥接手指血运。术后问卷调查患者对皮瓣外形满意度,评测皮瓣痛触觉、温度觉、两点辨别觉(mm),检测患者关节活动度TAM值及与健侧的比值。结果 7例手掌皮瓣均存活,远端断指恢复良好血运;4例术后6个月行二期皮瓣修整手术;7例获得有效随访,随访时间超过12个月,供区伤口均一期愈合,患者对后期皮瓣外形满意度高(7/7,100%),术后6个月皮瓣恢复两点辨别觉,12个月平均值为(10.75±2.10)mm,皮瓣感觉评级为S3+级,患指关节总TAM值与健侧的比值为(0.82±0.16)。结论以旋股外侧动脉降支为蒂的血流桥接皮瓣可以避免损伤主干血管,是桥接手掌毁损创面的一种安全、有效的术式。Objective To investigate the clinical efficacy of transplantation of flow-through anterolateral perforator-based thigh flaps in reconstruction of destructive wound of the palm. Methods From July 2011 to May 2012,a total of 7 patients with destructive wound of the palm underwent transplantation with flow-through flaps based on the descending branch of the lateral circumflex femoral artery,repairing the defects and restoring the blood circulation to the fingers. The questionnaires were used to evaluate the satisfaction of the patients to flap appearance. The sensation of pain, touch, temperature and two-point discrimination were evaluated. TAM value of joint flexibility in the diseased side was compared with that in the healthy side. Results The flaps in the seven cases all survived well. The distal circulation of the diseased finger recovered well. Four patients received the second-stage flap thinning 6 months after surgery. Seven patients were followed up for more than 12 months,with their wound healed at first stage. All patients were satisfied with the appearance of the flaps at later stage（7/7,100%）. The two- point discrimination recovered 6 months after surgery and the average value was （10. 75±2. 10） mm. The sensation of the flaps was graded as S3＋ and TAM evaluation ratio was （0.82±0.16）. Conclusion Use of flow-through flaps based on the descend- ing branch of the lateral circumflex femoral artery can avoid the damage of the trunk arteries of the thigh. It is a safe and effective procedure for restoring the destructive wound of the palm.

关 键 词：手掌 穿支 皮瓣 血流桥接 创面 移植 重建 

分 类 号：R658.2[医药卫生—外科学]