游离腓肠内侧动脉穿支皮瓣修复手部创面  

Reconstruction of the soft-tissue defects of the hand with free medial sural artery perforator flap

作　　者：张龙春[1] 陈莹[1] 王鹏[1] 丁晟[1] 马亮[1] 姚建民[1] 

机构地区：[1]杭州整形医院手外科,杭州310014

出　　处：《中华手外科杂志》2015年第3期191-194,共4页Chinese Journal of Hand Surgery

摘　　要：目的 探讨腓肠内侧动脉穿支皮瓣修复手部皮肤软组织缺损的临床疗效.方法 自2010年1月至2013年6月收治手部皮肤软组织缺损患者12例,采用游离腓肠内侧动脉穿支皮瓣移植修复.其中感染创面8例,清洁创面4例,创面面积为5cm×4cm～13cm×8cm;切取皮瓣面积为6 cm×4 cm～ 14 cm×9 cm.皮瓣的动脉与鼻烟窝处的桡动脉或分支吻合,静脉和桡动脉的伴行静脉或头静脉吻合.2例皮瓣通过缝合皮神经重建感觉.结果 术后10例皮瓣顺利存活;1例皮瓣边缘出现水泡,经拆线处理后存活;1例皮瓣下积血出现静脉危象,经清除积血引流处理后危象解除,皮瓣存活.受区和供区创面均Ⅰ期愈合,随访3～ 12个月,皮瓣色泽与受区相似,无明显臃肿,质地柔软,无一例发生溃疡,2例缝合皮神经的皮瓣感觉恢复到S3.9例皮瓣供区遗留线性瘢痕,3例遗留植皮瘢痕,肢体活动无影响.结论 腓肠内侧动脉穿支皮瓣的血管解剖较恒定,分离鳃剖皮瓣相对简单,皮瓣薄而柔软,受区外形较美观,供区创伤小,不损伤小腿主要血管和腓肠肌,是修复手部中小创面的良好选择.Objective To evaluate the clinical results of soft tissue coverage of the hand using free medial sural artery perforator flap.Methods From January 2010 to June 2013,12 cases of soft tissue defects of the hand with bone and tendon exposure were treated with medial sural artery perforator flap transfer.Of these defects,4 were clean wounds while the other 8 had infections.The sizes of the defect ranged from 5 cm × 4 cm to 13 cm× 8 cm.The sizes of the flaps ranged from 6 cm× 4 cm to 14 cm × 9 cm.The feeding artery of the flap was anastomosed with the radial artery or its branch in the anatomical snuff box.The flap vein was anastomosed with the radial concomitant vein or the cephalic vein.Sensation of the flap was restored in 2 cases with cutaneous nerve coaptation.Results Postoperatively 10 flaps survived uneventfully.Blisters occurred at the edge of one flap due to tension.After removal of a couple of stitches to release the tension,the flap survived.Another flap had venous crisis due to hematoma formation.Drainage of the hematoma rescued the flap.Primary wound healing was achieved at both the recipient and donor sites.Follow-up ranged from 3 to 12 months.The color of the flaps was comparable to that of the recipient sites.The flaps were supple and not bulky.There was no ulceration.Sensation of the 2 flaps that had cutaneous nerve repaired recovered to S3.As for the donor sites,9 cases had linear scars while the other 3 had skin grafts.Donor limb motor function was not impaired.Conclusion Medial sural artery perforator flap has fairly constant vascular anatomy which makes flap dissection relatively straightforward.The flap is thin and supple that results in good cosmetic appearance at the recipient site.It is less invasive since flap harvest does not require sacrificing major arteries and the calf muscles.This flap is a good option for coverage of small to medium size defects of the hand.

关 键 词：手损伤 外科皮瓣 显微外科手术 腓肠内侧动脉 

分 类 号：R658.305[医药卫生—外科学]