改良法重建感觉的近端尺动脉穿支皮瓣修复相邻指腹缺损的临床观察  被引量:10

Reconstruction of adjacent large finger pulps with the modified sensate free proximal ulnar artery perforator flap

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作  者:潘佳栋[1] 李苗钟 王科杰[1] 黄耀鹏[1] 王胜伟[1] 尹善青[1] 丁文全[1] 郭浩[1] 王欣[1] Pan Jiadong;Li Miaozhong;Wang Kejie;Huang Yaopeng;Wang Shengwei;Yin Shanqing;Ding Wenquan;Guo Hao;Wang Xin(Deportment of Hand Surgery,Ningbo NO.6 Hospital,Ningbo,Zhejiang Province 315040,China)

机构地区:[1]宁波市第六医院手外科,浙江省宁波市315040

出  处:《中华显微外科杂志》2018年第4期329-333,共5页Chinese Journal of Microsurgery

基  金:浙江省自然科学基金(LY13H060008);宁波市自然科学基金(2016A610012)

摘  要:目的探讨用改良方法重建感觉的游离近端尺动脉穿支皮瓣修复相邻大面积指腹缺损的手术技术和临床疗效。方法从2013年2月至2016年5月,采用游离近端尺动脉穿支皮瓣修复相邻指腹缺损共10例20指,其中示、中指和中、环指指腹缺损分别为4例8指、6例12指。术中将皮瓣内皮神经近、远两端分别与相邻2手指相对侧指掌侧固有神经端端吻接,术后7周行分指术时解剖、切断皮瓣内皮神经,将两断端分别与相邻侧指掌侧固有神经吻接,由此重建2个手指指腹的感觉。皮瓣移植时吻接皮神经近端10指(A组)、远端10指(B组)。尺动脉穿支与患指指掌侧固有动脉(6例)或其关节支(4例)端端吻合,皮瓣面积5.0cm×3.5cm^5.5cm×4.0cm。术后定期随访。结果9例皮瓣顺利成活,1例出现静脉危象,经皮瓣表面针刺放血等处理后成活。分指术后皮瓣均无淤血或缺血表现。术后随访11~32个月(平均17个月),两组各10指皮瓣的两点辨别觉分别为(7.3±1.2)mm和(8.6±2.4)mm,差异无统计学意义(P〉0.05);行Semmes-Weinstein单丝触觉评估,14指为轻触觉减退,6指为保护性感觉减退:术后全关节主动活动度为(248.0±4.5)°。患者主诉皮瓣轻度疼痛l例1指,均未出现皮瓣不耐寒症状,所有患指无捏物不稳情况。结论游离近端尺动脉穿支皮瓣血管解剖相对恒定,血供可靠,皮肤颜色、质地和柔韧度与指腹接近,经改良后可同时重建相邻2个患指的感觉.是相邻大面积指腹创面修复的一种良好选择.Objective To study the surgical techniques and the clinical curative effect of the reconstruction of adjacent large finger pulps with the modified sensate free proximal ulnar artery perforator flap. Methods From February, 2013 to May, 2016, 20 fingers in 10 patients with adjacent large finger pulp defects crossing the DIP joint were reconstructed by the modified senate free proximal ulnar artery perforator flap. All the pulps of every patient were recovered by 1 flap in the first stage and the artificial syndactyly of two digits was divided in 7 weeks after the flap transfer in the second stage. In order to reconstruct the sensation of two pulps in each patient, firstly both of the proximal and distal ends of the cutaneous nerve in flaps were dissected and anastomosed with the most lateral and medial palmar digital nerves of two adjacent fingers respectively, which were divided into 2 groups. Secondly the cutaneous nerve in the middle part of flap was cut and the two ends were anastomosed with the other two palmar digital nerves in the second surgery. There were 8 fingers in 4 patients with the index and middle finger pulp defects, 12 fingers in 6 patients with the middle and ring finger defects. The flap size was from 5.0 cm×3.5 cm to 5.5 em×4.0 cm, and the perforator artery was anastomosed with the palmar digital artery in 6 cases and with the joint branch of digital artery in 4 cases. Results Nine flaps survived uneventfully except the venous congestion was found in 1 flap which was salvaged successfully by acupuncture bleeding. Also, no congestion or ischemia of all the 20 pulp flaps occurred right after releasing the artificial syndactyly. The time of followed-up was from 11 months to 32 months with the average of 17 months after the second surgery. The static two point discrimination of the 2 groups of the sensate pulp flap was (7.3 ±1.2) ram and (8.6±2.4)ram respectively. There was no significant difference between groups (P〉0.05). These 20 pulp flaps were also assessed by the Semmes-Wein

关 键 词:尺动脉穿支皮瓣 指掌侧固有动脉 指缺损 感觉重建 

分 类 号:R658.2[医药卫生—外科学]

 

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