邻指指动脉岛状皮瓣修复手指软组织缺损并重建血运  

Application of proper digital artery island flaps of adjacent digit for repair of finger soft tissue defects and reconstruction of blood circulation

作　　者：刘刚义[1] 郑龙[1] 刘宗义[1] 苟军全[1] 石定[1] 宋永斌[1] 谢瑞菊[1] 

机构地区：[1]解放军第三医院手外科,陕西宝鸡721006

出　　处：《中华手外科杂志》2017年第5期352-354,共3页Chinese Journal of Hand Surgery

摘　　要：目的研究采用邻指指动脉岛状皮瓣转移修复手指软组织缺损并重建血运的手术方法和临床疗效。方法自2010年3月至2015年5月，我们采用邻指指动脉岛状皮瓣转移修复手指软组织缺损并重建血运21例。血管、神经缺损范围为1．5—4．0cm，皮肤软组织缺损范围为1．5cm×1．0cm～4．0cm×2．0cm。术中于患指邻指的相邻侧缘切取所需指动脉及其走行上的岛状皮瓣，转移重建指体血液循环，并同时修复皮肤软组织缺损，神经缺损采用前臂或足背皮神经移植桥接。结果本组2例术中游离过程即发生血管痉挛，经局部应用罂粟碱及温热生理盐水热敷后解除。1例术后2h发生血管危象，经手术探查后解除。其余皮瓣及指体均顺利存活。术后随访时间为6～48个月，平均18个月。皮瓣外形、质地均良好，恢复部分感觉，指体恢复原有外形及功能。供指均无功能影响。按中华医学会手外科学会上肢部分功能评定试用标准评定：优13例，良6例，可2例。结论采用邻指指动脉岛状皮瓣转移修复手指软组织缺损并重建血运，不但具备血流桥接皮瓣的临床疗效，还具有手术操作简捷、安全、可靠等优点，值得推广。Objective To research the surgical procedure and clinical effects of proper digital artery island flaps of adjacent digit for repair of finger soft tissue defects and reconstruction of blood circulation. Methods From March 2010 to May 2015, 21 cases of finger soft tissue defects were treated with proper digital artery island flaps of adjacent digit. The artery or nerve defect ranged from 1.5 to 4.0 cm. The skin and soft tissue defects area ranged from 1.5 cm × 1.0 cm to 4.0 cm ×2.0 cm. During the operation, proper digital artery and its island flaps were obtained from adjacent side margin of adjacent digit, and transferred to repair skin and soft tissue defects and reconstruct blood circulation simultaneously. The nerve defect was bridged by forearm or foot dorsal cutaneous nerve graft. Results Vasospasru occurred in 2 cases during intraoperative dissection, which was relieved after local application of papaverine and hot warm saline. Vascular crisis occurred in one case 2 hours after the operation, which was relieved by operative exploration. The rest flaps survived uneventfully. The follow-up period ranged from 6 to 48 months with the average being 18 months. The appearance and texture of the flaps were good. Partial protective sensations were restored. The original appearance and function of the injured finger were recovered. No dysfunction occurred in donor fingers. According to the functional evaluation standards issued by Hand Surgery Society of the Chinese Medical Association, the results were excellent in 13 cases, good in 6 cases, fair in 2 cases. Conclusion Application of proper digital artery island flaps of adjacent digit for repair of finger soft tissue defects and reconstruction of blood circulation not only has the clinical effect of flow-through flap, but also has the advantages of simplicity, safety and reliability, which is worth promoting.

关 键 词：指损伤 外科皮瓣 血流桥接皮瓣 转移修复 

分 类 号：R658.2[医药卫生—外科学]