改良指掌侧固有动脉岛状皮瓣修复烧伤后指屈曲挛缩畸形  

The modified antegrade digital artery island flap for severely flexion contracture of the burned finger

作　　者：冯仕明[1] 丁朋[1] 王爱国[1] 张在轶 程建[1] 孙擎擎[1] 武艳云[1] 

机构地区：[1]徐州市中心医院手足显微外科,江苏省徐州市221009

出　　处：《中华显微外科杂志》2016年第5期445-448,共4页Chinese Journal of Microsurgery

基　　金：江苏省临床医学科技专项项目（BL2013005）;江苏省卫生厅课题项目（H201441）;南京市科技发展计划项目（201503038）;南京市医学科技发展资金（ykkl3150）

摘　　要：目的探讨采用携带指固有神经背侧支的改良指掌侧固有动脉顺行岛状皮瓣修复手指烧伤性屈曲挛缩畸形的临床疗效。方法2013年8月-2015年8月，共收治21例21指手指烧伤性屈曲挛缩畸形患者。所有患者屈曲挛缩程度按照Stern等对手指指间关节屈曲挛缩的分型标准，均为Ⅲ型。术中屈曲手指矫正后，掌侧皮肤软组织缺损面积为1.0 cm × 2.0 cm^2.5 cm × 4.0 cm，动脉缺损长度为1.5~4.5 cm，神经缺损长度为2.0~4.2 cm。矫形术后的创面及动脉、神经缺损采用改良指掌侧固有动脉岛状皮瓣进行修复。皮瓣内携带的指固有神经背侧支与创面两端的神经断端进行端端吻合以修补神经缺损并重建感觉功能。皮瓣供区取臂内侧全厚皮片游离植皮。术后定期回医院门诊复诊随访。结果21例21指手术均顺利实施，创面均Ⅰ期愈合，所有皮瓣及植皮均获成活，术后随访6~22个月，平均11.5个月。皮瓣及其供区外形恢复满意，未见明显色素沉着及瘢痕挛缩，患指均获矫正且未出现冷不耐受。皮瓣两点辨别觉为4.3~6.5 mm，平均5.2 mm。按照Michigan问卷评定患者对手外观及功能的满意度，非常满意18例，满意3例。结论携带指固有神经背侧支的改良指掌侧固有动脉岛状皮瓣，可同时修复神经及动脉缺损，安全可靠，术后外观及感觉恢复好，是修复手指烧伤性屈曲挛缩畸形的有效方法。Objective To investigate the clinical outcomes of using modified antegrade digital artery island flap for the treatment of the severely flexion contracture of the burned finger. Methods Between August, 2013 to August, 2015, 21 patients （21 fingers） with severely flexion contraeture of the burned finger were hospitalized for treatment. According to the Stren classification standard for the interphalangeal joint flexion eontracture, all the patients were rated as type m. The volar soft-tissue defect with exposed tendons, nerves, vessels or bone ranged from 1.0 cm ~ 2.0 cm to 2.5 cm x 4.0 cm after scar relaxation. The artery and the nerve defect were 1.5 to 4.5 cm and 2.0 to 4.2 cm, respectively. The wound were reconstructed with the modified antegrade digital artery island flap. The dorsal branches of the proper digital nerve of the flap were anastomosised with the proper digital nerve of the wound. The flap donor site was resurfaced with full-thickness skin grafting from inner aspect of the forearm. All the cases were called back for postoperative follow-up. Results All the reconstructed fingers and flaps survived completely without vascular problems. The donor skin graft survived and wound healed by first intention. All the patients were followed up with 11.5 months （range, 6-22 months）. The finger appearance was satisfactory. The texture and color of flaps in all cases were good. There was no pigmentation and contraction relapse. The contracted fingers received no cold intolerance. At the final examination, the average values of static 2-point discrimination were 5.2 mm （range, 4.3-6.5 mm） of the flap. In the series, based on the Michigan Hand Outcome Questionnaire, 18 patients were strongly satisfied with the injured finger appearance and 3 patients satisfied with the appearance. Conclusion The modified antegrade digital artery island flap, which is easy to raise with large flap size and can result with the good finger appearance and function, is an ideal technique for reconstruction of the severe f

关 键 词：指 烧伤 指屈曲挛缩畸形 指掌侧固有动脉 岛状皮瓣:显微外科手术 

分 类 号：R644[医药卫生—外科学]