掌深弓手背穿支蒂筋膜皮瓣修复指蹼区皮肤软组织缺损的临床效果  

Clinical effects of dorsal perforator fascia pedicle flap of the deep palmar arch in the repair of skin and soft tissue defects of finger web area

作　　者：林涧[1] 张天浩[1] 胡德庆[2] 王之江[1] 刘蔡钺 郑和平[4] Lin Jian;Zhang Tianhao;Hu Deqing;Wang Zhijiang;Liu Caiyue;Zheng Heping(Department of Orthopaedics,Xinhua Hospital (Chongming),Shanghai Jiao Tong University School of Medicine,Shanghai 202150,China;Department of Orthopaedics,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350000,China;Department of Burns and Plastic Surgery,Shanghai Changzheng Hospital,Shanghai 200003,China;Department of Comparative Medicine,Fuzhou General Hospital of Nanjing Military Command,Fuzhou 350025,China)

机构地区：[1]上海交通大学医学院附属新华医院(崇明)骨科,202150 [2]福建医科大学附属第一医院骨科,福州350000 [3]上海长征医院烧伤整形外科,200003 [4]南京军区福州总医院比较医学科,350025

出　　处：《中华烧伤杂志》2019年第7期490-494,共5页Chinese Journal of Burns

基　　金：上海市科研计划(14411973200);上海市卫生和计划生育委员会科研课题(201840198);上海市崇明县科技攻关基金项目(CKY2015-05).

摘　　要：探讨掌深弓手背穿支蒂筋膜皮瓣修复指蹼区皮肤软组织缺损的临床疗效。方法2010年10月—2018年9月,上海交通大学医学院附属新华医院(崇明)收治11例手背远端指蹼区皮肤软组织缺损患者(男7例、女4例,年龄18~73岁),缺损面积为2.5cm×1.5cm^6.0cm×2.5cm。根据掌深弓手背穿支的起源、走行、分支与分布和掌深弓手背穿支与腕背、掌背血管网的吻合解剖学特点,于患手手背设计掌深弓手背穿支蒂筋膜皮瓣转位修复手背远端指蹼区缺损创面,本组患者皮瓣切取面积为3.5cm×2.0cm^6.5cm×3.0cm。供区直接拉拢缝合或以游离患侧前臂全厚皮覆盖。术后随访3~36个月,评估患者创面修复疗效和皮瓣早期、后期肿胀程度。结果11例患者皮瓣术后全部顺利成活,供受区创面愈合。术后随访3~36个月,皮瓣存活良好,形态较佳,色泽弹性与周围正常皮肤接近,皮瓣两点辨别觉距离为7~10mm,感觉功能恢复均为S3级;供区创面无感染,愈合后瘢痕较小。根据疗效评价:满意8例、一般3例、无不满意。皮瓣肿胀程度评价:早期,Ⅰ度7例、Ⅱ度2例、Ⅲ度2例;后期,Ⅰ度8例、Ⅱ度2例、Ⅲ度1例。手部掌指关节和指间关节活动基本正常,患者对治疗效果满意。结论以掌深弓手背穿支为蒂,形成掌深弓手背穿支蒂筋膜皮瓣转位修复手背远端指蹼区皮肤软组织缺损创面,疗效可靠,具有临床推广价值。Objective To explore the clinical effects of dorsal perforator fascia pedicle flap of the deep palmar arch in the repair of skin and soft tissue defects of finger web area.Methods Eleven patients(7 males and 4 females,aged from 18 to 73 years)with soft tissue defects of finger web area in distal dorsal side were admitted to Xinhua Hospital(Chongming)of Shanghai Jiao Tong University School of Medicine from October 2010 to September 2018.The sizes of skin and soft tissue defects ranged from 2.5 cm×1.5 cm to 6.0 cm×2.5 cm.According to the origin,course,branches,and distribution of the dorsal perforator of deep palmar arch,and the anatomical characteristics with vascular network of dorsal carpal and dorsal metacarpal,dorsal perforator fascia pedicle flaps of the deep palmar arch from the back of the injured hands were designed and transferred to repair the wounds of finger web area in distal dorsal side.The sizes of the flaps of patients ranged from 3.5 cm×2.0 cm to 6.5 cm×3.0 cm.The donor sites were sutured directly or covered with free forearm full-thickness skin graft.The clinical effects and swelling degree of flaps in early and late stages were evaluated during the follow-up of 3 to 36 months post surgery.Results All the flaps survived in 11 patients,the incisions in donor and recipient sites were healed.During the follow-up of 3 to 36 months post surgery,the survival of flaps was good,and the appearance,color,and elasticity were close to normal skin,with two-point discrimination distance of 7 to 10 mm and sensory function recovery of grade S3.The wounds in donor site had small scar without infection.The efficacy was evaluated as satisfactory in 8 patients,general in 3 patients,and dissatisfactory in no patient.Flap swelling rating in early stage was 1st degree in 7 patients,2nd degree in 2 patients,and 3rd degree in 2 patients.Flap swelling rating in late stage was 1st degree in 8 patients,2nd degree in 2 patients,and 3rd degree in 1 patient.The extension and flexion of the metacarpal and interphalangeal jo

关 键 词：外科皮瓣 掌深弓 穿支 组织缺损 修复 

分 类 号：R658.2[医药卫生—外科学]