上臂内侧游离皮瓣修复手部皮肤缺损的临床应用  

Clinical application of the medial upper arm free flap for repair of skin defect of the hand

作　　者：庄加川[1] 李敏姣[1] 陈乐锋[1] 陈国荣[1] 叶学浪[1] 张振伟[1] 

机构地区：[1]广州医科大学附属深圳沙井医院手外科,深圳518104

出　　处：《中华手外科杂志》2015年第3期185-187,共3页Chinese Journal of Hand Surgery

基　　金：深圳市卫生和人口计划生育委员会立项项目（201302170）

摘　　要：目的 探讨应用上臂内侧游离皮瓣修复手部皮肤缺损的临床效果.方法 自2010年4月至2013年3月对10例手部皮肤缺损患者采用上臂内侧皮瓣游离移植修复,行尺侧上副动脉-手部受区动脉、伴行静脉或皮下静脉-手背静脉吻合重建皮瓣血液循环,上臂供区直接缝合闭合创面.结果 10例上臂内侧游离皮瓣全部存活;1例术后出现血管危象,手术探查发现动脉吻合口内有血栓形成,取出血栓后重新吻合血管后皮瓣存活.2例术后3个月行皮瓣整形术.8例患者术后随访2个月至2年,平均11个月,手部皮瓣外观满意,质地好,未见明显萎缩.手指屈伸活动功能恢复良好,屈曲75°～ 90°,伸直-5°～0°.上臂内侧供区创面仅留线性瘢痕.结论 上臂内侧游离皮瓣修复手部皮肤缺损是一种较理想的方法.Objective To evaluate the clinical results of medial upper arm free flap transfer in the treatment of skin defects of the hand.Methods From April 2010 to March 2013,a total of 10 cases of skin defects of the hand were treated with medial upper arm flap transfer.Flap circulation was re-established by anastomosing the superior ulnar collateral artery to the recipient artery of the hand,and the concomitant vein or subcutaneous vein to the dorsal veins of the hand.The donor site wound was directly closed.Results All 10 flaps survived completely.Vascular crisis occurred in 1 case.Surgical exploration revealed a thrombus at the artery anastomosis site.The flap survived after removal of the thrombus and re-anastomosis of the arteries.Two cases underwent flap de-bulking procedures 3 months postoperatively.Eight of the 10 cases had postoperative follow-up ranging from 2 months to 2 years with an average of 11 months.The appearance of the flaps at the hand was satisfactory.Flap texture was good with no obvious atrophy.Range of motion of the fingers recovered well.Finger flexion achieved 75° to 90°while finger extension-5° to 0°.The donor site wound was concealed with only linear scar.Conclusion Medial upper arm free flap transfer is an ideal option for repairing skin defects of the hand.

关 键 词：手损伤 外科皮瓣 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]