改良动脉化静脉皮瓣在伴有环形皮肤软组织缺损断指再植中的应用  

The improved arterialized venous flaps＇ application in the replantation of finger with annular skin-soft tissue defects

作　　者：何明飞[1] 吴建伟[1] 李亮[1] 黄忠明[1] 吴详 陆蕴红[1] 陈毅城 雷彦文[1] 张敬良[1] 

机构地区：[1]广州中医药大学顺德和平外科医院手显微外科,广东省佛山市528308

出　　处：《中华显微外科杂志》2015年第5期432-434,共3页Chinese Journal of Microsurgery

基　　金：佛山市医学类科技公关项目（2014AB001993）

摘　　要：目的 探讨应用改良的动脉化静脉皮瓣在伴环形皮肤软组织缺损的手指离断再植中的临床疗效. 方法 根据缺损大小及血管修复要求,在前臂设计改良动脉化静脉皮瓣,桥接伴有环形皮肤软组织缺损的断指再植23例31指,其中19例并有指骨骨折,13例伴指固有神经缺损,创面位于甲根至掌指关节平面段范围,远端均有尚完整指体,均需重建血液循环,皮肤缺损面积1.0 cm×3.5 cm ～ 4.0 cm×7.5 cm,均为急诊修复.结果 皮瓣及再植手指均全部成活,1例皮瓣部分皮肤坏死,经换药后愈合.术后随访2 ～ 39个月,2指远端指体有不同程度萎缩,3指皮瓣稍臃肿,余皮瓣外观良好,两点辨别觉为8～ 15 mm,远端指体为5～ 12mm. 结论 对伴环形皮肤软组织缺损的离断手指应用改良的动脉化静脉皮瓣进行搭桥修复、再植手术可取得满意的疗效.Objective To explore the clinical effect of applicating the improved arterialized venous flaps in the replantation of finger with annular skin-soft tissue defects.Methods According to the size of the amputated finger soft tissue defects and the repair requirements, the improved arterialized venous flaps were designed on the forearm.The improved arterialized venous flaps were applicated in 23 cases of 31 fingers with annular skin-soft tissue defects in the flow-through operations and replantation operations.Among these cases, there were 19 cases with finger fracture and 13 cases with finger nerve defects.These wounds which with complete part of finger on the far-end were appeared between the nail root to the metacarpophalangeal joint.All wounds were demanded to be rebuihed the blood circulation and repaired urgently.The defects＇area was between 1.0 cm × 3.5 cm to 4.0 cm × 7.5 cm.Results All fiaps successfully survived except one flap partially necrosised, which was cured after wound dressing change.Followed-up from 2 to 39 months, 2 fingers in different degrees of atrophy, and 3 finger flaps lightly bloated.Other remaining flaps were in good appearance.The two-point discrimination of the flaps was 8-15 mm, and the far-end fingers＇two-point discrimination was 5-12 mm.Conclusion It can be a satisfied curative effect to applicating the improved arterialized venous flaps in the replantation of finger with annular skin soft tissue defects.

关 键 词：断指再植 静脉皮瓣 动脉化 环形软组织缺损 

分 类 号：R658.1[医药卫生—外科学]