静脉外增压技术在第1掌骨背筋膜蒂皮瓣中的应用  

Application of the technique of supercharge of vei in the skin flap of the first dorsal metacarpal fascial pedicle

作　　者：安玉章 文雪平 马剑 郑明 黄斌 蒋电明 AN Yu-zhang;WEN Xue-ping;MA Jian;ZHENG Ming;HUANG Bin;JIANG Dian-ming(Bone and Trauma Center,Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Department of Orthopedics,First People’s Hospital of Chongqing Liangjiang New Area,Chongqing 401121,China)

机构地区：[1]重庆医科大学附属第三医院(捷尔医院)骨与创伤中心,重庆401120 [2]重庆市两江新区第一人民医院骨科,重庆401121

出　　处：《中国医刊》2020年第4期387-389,共3页Chinese Journal of Medicine

基　　金：国家自然科学基金(81472057)。

摘　　要：目的探讨静脉外增压技术在第1掌骨背筋膜蒂皮瓣中的应用效果。方法回顾性分析2018年1月至2019年4月在重庆医科大学附属第三医院采用第1掌骨背筋膜蒂皮瓣修复创面的15例(15指)拇指指端缺损患者,术中转移皮瓣覆盖创面后将皮瓣近端的1条浅静脉断端与创面皮下静脉残端缝合,形成皮瓣静脉外增压,术后观察皮瓣血运、水疱形成情况等及远期外观、手指功能情况。结果所有皮瓣及供区植皮均存活,术后2周内皮瓣无水疱形成及青紫等情况发生。术后6~8个月随访时见皮瓣质地柔软,无臃肿,部分皮瓣色素沉着,皮瓣痛温觉均恢复,手指各关节活动良好,两点分辨率及手指寒冷耐受情况良好。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优10指,良4指,可1指。结论在第1掌骨背筋膜蒂皮瓣中应用静脉外增压技术可获得良好的临床效果。Objective To explore the effect of Extravenous pressure on the flap pedicled with dorsal metacarpal fascia. Method From January 2018 to April 2019, the first metacarpal dorsal fascial flap was used to repair the defect of 15 thumbs and fingers in our hospital. After the flap was transferred to cover the wound, the broken end of a superficial vein near the flap was sutured with the residual end of the subcutaneous vein of the wound to form the extra venous pressure of the flap. After the operation, the blood circulation, blister, long-term appearance and finger function of the flap were observed. Result All flaps and donor areas survived. There was no blister formation and skin flap cyanosis in the endothelial flap 2 weeks after the operation. After 6-8 months of follow-up, the skin flap was soft and without swelling, some flaps were pigmented, the pain and temperature of the skin flap recovered, and the joints of fingers were in good motion. According to the evaluation criteria of upper limb function of Hand Surgery Society of Chinese Medical Association: excellent 10 fingers, good 4 fingers, fair 1 finger. Conclusion Compared with the traditional operation, the first dorsal metacarpal fascial flap can get better prognosis.

关 键 词：静脉外增压 筋膜蒂 静脉吻合 疗效 

分 类 号：R658.2[医药卫生—外科学]