掌背动脉复合组织皮瓣一期修复手指皮肤伴肌腱缺损的临床应用  

Clinical application of dorsal metacarpal artery composite flap for coverage of tendon and skin defects of the fingers

作　　者：周飞亚[1] 高伟阳[1] 蒋良福[1] 池征璘[1] 杨景全[1] 宋永焕[1] 丁健[1] 褚庭纲[1] 

机构地区：[1]温州医科大学附属第二医院手外科,浙江325027

出　　处：《中华手外科杂志》2016年第5期352-354,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨利用掌背动脉皮瓣携带示指（小指）固有伸肌腱和掌背皮神经一期修复手指皮肤伴伸肌腱缺损的手术方法及治疗效果。方法自2013年4月至2015年9月，我们以掌背动脉复合组织皮瓣一期修复6例6指中末节指背皮肤伴伸肌腱缺损患者。切取皮瓣面积6．0cm×2．0cm～7．0cm×3．0cm，供区直接拉拢缝合。术后1周开始行手指被动功能锻炼并持续4至6周。结果术后皮瓣均存活，所有患者均获得随访，时间为3～13个月，平均8．2个月，皮瓣感觉恢复至S3，静态两点分辨觉为7-10mm，平均8．6mm，术后手指外观及关节活动范围等令人满意。结论掌背动脉复合组织皮瓣一期修复指背复合组织缺损符合现代显微外科理念。掌背动脉皮瓣血管恒定，手术操作简便、安全，覆盖创面的同时修复肌腱及神经缺损，缩短了患者治疗时间，提高治疗质量。Objective To discuss the surgical techniques and treatment outcomes of one-stage repair of complex soft tissue and extensor tendon defect of the fingers by transferring dorsal metacarpal artery flap that includes extensor indicis proprius （extensor digiti minimi proprins） tendon and dorsal cutaneous nerve. Methods From April 2013 to September 2015, 6 cases of middle finger dorsal complex tissue defect were managed with dorsal metacarpal artery composite flap transfer for skin coverage, extensor tendon repair and sensory restoration. The flap size that covered these defects ranged from 6.0 cm × 2.0 cm to 7.0 cm × 3.0 cm. The donor site was directly closed. Passive functional exercise was initiate done one week postoperatively and lasted for 4 to 6 weeks. Results All 6 flaps survived completely. All the patients were follow-up for 3 to 13 months with an average of 8.2 months. Sensation of the flaps recovered to S3 level. Two-point discrimination was 7 to 10 mm while the mean value was 8.6 mm. The color,texture and contour of the flaps were good. Mobility of the hand was satisfactory. Conclusion Dorsal metacarpal artery composite flap transfer is a reliable way to cover complex tissue defects on the dorsum of fingers. It has consistent vascular anatomy, affords externsor tendon and cutaneous nerve reconstruction along with skin coverage, shortens treatment time, and improves outcomes without added risks.

关 键 词：外科皮瓣 指损伤 掌背动脉 复合组织瓣 

分 类 号：R658.2[医药卫生—外科学]