腓肠内侧动脉穿支皮瓣游离移植修复重度虎口瘢痕挛缩  

Application of free medial sural artery perforator flap for repair of severe thumb web scar contracture

作　　者：陈彦名[1] 唐举玉[2] 谢松林[1] 刘鸣江[1] 夏晓丹[1] 邓翔午[1] 

机构地区：[1]南华大学附属南华医院手足外科,湖南衡阳421002 [2]中南大学湘雅医院骨科,长沙

出　　处：《中华手外科杂志》2017年第3期190-192,共3页Chinese Journal of Hand Surgery

基　　金：衡阳市应用基础研究计划项目（2014KJ56）

摘　　要：目的探讨腓肠内侧动脉穿支皮瓣治疗重度虎口瘢痕挛缩的临床疗效。方法自2012年10月至2015年3月，对14例重度虎口瘢痕挛缩患者行瘢痕切除、虎口开大后，采用腓肠内侧动脉穿支皮瓣移植修复，皮瓣切取面积为5cm×4cm-9cm×6cm，术后通过观察皮瓣外形、感觉恢复隋况、虎口张开角度、虎口宽度以及供区恢复睛况评估其疗效。结果14例皮瓣全部存活，虎口饱满，外形满意，无继发挛缩，供区创面I期愈合。术后随访时间12-18个月（平均14个月），术前虎口张开角度（15±5）°、术后（80±6）°，术前宽度（20．0±3．5）mm、术后（45．0±5．6）mm。拇指的外展、内收及对掌功能明显改善。术后皮瓣均恢复了保护性感觉，其中6例缝合腓肠内侧皮神经的感觉恢复到S3。供区肢体活动无影响。结论腓肠内侧动脉穿支皮瓣穿支较为恒定，修复虎口外形满意，供区创伤小，是一种修复重度虎口挛缩的有效方法。Objective To explore the clinical effect of free medial sural artery perforator （MSAP） flap for repair of severe thumb web scar contracture. Methods From October 2012 to March 2015, 14 cases of severe thumb web scar eontracture were repaired with free MSAP flap after scar excision. The flap areas ranged from 5 cm×4 cm to 9 cm×6 cm. The clinical outcomes were evaluated by the appearance of transplanted flaps, sensory recovery, opening angle and width of thumb web and donor site recovery at postoperative follow-up. Results All 14 flaps survived uneventfully. The thumb webs were well- stacked with satisfactory shapes. There was no secondary contracture. Primary healing was achieved at donor sites. Postoperative follow-up ranged from 12 to 18 months, with an average of 14 months. Postoperative angle of repaired thumb webs was enlarged to （80±6）° from preoperative angle of （15±5）°. And the width was enlarged to （45.0±5.6） mm from （20.0±3.5） mm. Thumb functions of abduction, adduction and opposition were all improved obviously. All flaps restored protective sensation. Six cases with anastomosis of medial sural cutaneous nerve recovered to S3. No functional damage was observed at donor sites. Conclusion MSAP flap is an effective way to repair severe thumb web contracture because of its constant perforator, satisfactory shape of repaired thumb webs and minor damages to donor sites.

关 键 词：外科皮瓣 移植 腓肠内侧动脉穿支 虎口挛缩 

分 类 号：R658.2[医药卫生—外科学]