第三掌背动脉穿支蒂逆行岛状皮瓣修复中指尺侧缺损的临床研究  

Clinical study of reversed island flap pedlcled with the third dorsal metacarpal artery branch for repair of ulnar defect of middle finger

作　　者：韩超前[1] 侯小赛[1] 温树正[1] 郭卫春[1] Han Chaoqian Hou Xiaosai Wen Shuzheng Guo Weichun.(Department of Orthopedics, People＇s Hospital of Wuhan University, Wuhan 430060, Chin)

机构地区：[1]武汉大学人民医院骨科,武汉430060

出　　处：《中华手外科杂志》2017年第4期261-263,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨第三掌背动脉穿支蒂逆行岛状皮瓣修复中指尺侧缺损的方法及临床疗效。方法自2013年8月至2016年3月，对12例中指尺侧皮肤软组织缺损伴肌腱或指骨外露患者，采用第三掌背动脉穿支蒂逆行岛状皮瓣修复，术中在第三掌背动脉腕横纹处至第三、四掌骨头间设计皮瓣，皮瓣呈梭形或椭圆形，面积为5．5cm×2-5cm～2．5cm×1．2cm。结果术后12例皮瓣全部存活；3例皮瓣出现红肿现象，使用肝素钙3d，抗生素7d，经20d左右伤口换药后皮瓣血运恢复正常，伤口愈合良好。随访时间为6-9个月，平均6,8个月。皮瓣颜色、外形良好，质地柔软、伸缩性良好，无压痛，供区无明显不适。两点分辨觉为7-11mm，平均9．3mm。根据中华医学会手外科学会上肢部分功能评定试用标准评定：中指TAM为209．27±15．10，优7例，良5例。结论第三掌背动脉穿支蒂逆行岛状皮瓣修复中指尺侧缺损，皮瓣的血运、外形、感觉良好，是一种临床实用性强的修复方法。Objective To explore the clinical effect of reversed island flap pedicled with the third dorsal metacarpal artery branch in the treatment of ulnar defect of middle finger. Methods From August 2013 to March 2016, 12 cases of ulnar skin and soft tissue defects of middle finger accompanied with exposure of phalanx or tendons were treated by reversed island flap pedicled with the third dorsal metacarpal artery branch. The flap was designed between the wrist of the third dorsal metacarpal artery and the third and fourth metacarpal bones. Flap shape was spindle or oval. The flap areas ranged from 5.5 cm × 2.5 cm to 2.5 cm×1.2 cm. Results All 12 flaps survived. The flaps showed red and swelling in 3 cases. The heparin calcium was used for 3 days and the antibiotic for 7 days. After about 20 days of wound dressing, blood supply of the flaps returned to normal and the wound healed well. The mean follow-up time was 6.8 months （range, 6 to 9 months）. The color, shape, texture, elasticity of the flaps was good without tenderness. No obvious discomfort in donor site. Two-point discrimination of flaps ranged from 7 to 11 mm, with an average of 9.3 mm. According to upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the total active movement of middle finger was 209.27-4-15.10. The results were graded as excellent in 7 cases and good in 5 cases, Conclusion Reversed island flap pedicled with the third dorsal metacarpal artery branch is a useful method to repair ulnar defect of middle finger because of the good blood supply, appearance and sensory recovery.

关 键 词：指损伤 外科皮瓣 第3掌背动脉 缺损 

分 类 号：R658.2[医药卫生—外科学]