游离带感觉神经肋间动脉穿支皮瓣移植修复手外伤缺损  

Free sensate intercostal artery perforator flap for hand soft tissue reconstruction

作　　者：张兴群[1] 姚毅 饶磊 秦振波 张龙春[2] 徐一波[2] 陈莹[2] 姚建民[2] 宋达疆[3] ZHANG Xingqun;YAO Yi;RAO Lei;QIN Zhenbo;ZHANG Longchun;XU Yibo;CHEN Ying;YAO Jianmin;SONG Dajiang(Department of Hand Surgery and Plastic Surgery,the First People’s Hospital of Yuhang District,Hangzhou Zhejiang,311100,P.R.China;Department of Plastic Surgery,Hangzhou Plastic Surgery Hospital,Hangzhou Zhejiang,310013,P.R.China;Department of Oncology Plastic Surgery,Hunan Cancer Hospital,Changsha Hunan,410008,P.R.China)

机构地区：[1]杭州市余杭区第一人民医院手外整形科,杭州311100 [2]杭州整形医院整形美容外科,杭州310013 [3]湖南省肿瘤医院肿瘤整形外科,长沙410008

出　　处：《中国修复重建外科杂志》2020年第4期497-500,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：湖南省自然科学基金面上项目(2018JJ2241、2018JJ2242);湖南省科技计划项目(2014SK3002);湖南省卫计委课题项目(B2014-111);湖南省肿瘤整形外科临床医学研究中心平台建设专项资助(2013TP4087)。

摘　　要：目的探讨游离带感觉神经肋间动脉穿支皮瓣移植修复手外伤缺损的疗效。方法2010年3月—2015年9月采用游离带感觉神经肋间动脉穿支皮瓣移植修复19例手外伤缺损,其中男16例,女3例;年龄18~53岁,平均35.2岁。手背15例,手掌4例。致伤原因:交通事故伤8例,热压伤5例,绞压伤4例,撕脱伤2例。均为手部大面积皮肤软组织全层缺损合并指骨、肌腱、血管神经外露,缺损范围为10.0 cm×7.0 cm^17.0 cm×8.0 cm。其中急诊手术12例,择期手术7例。皮瓣厚度为10~25 mm,皮瓣切取范围为10.0 cm×7.5 cm^17.0 cm×8.0 cm。皮瓣血管蒂与桡动脉鼻烟窝支(12例)、桡动脉主干(7例)及其伴行静脉吻合,皮瓣内肋间神经皮支与前臂外侧皮神经缝合。供区创面直接闭合(14例)或行中厚皮片移植修复(5例)。结果术后皮瓣及植皮均成活,供受区创面均Ⅰ期愈合。19例患者均获随访,随访时间10~18个月,平均12.7个月。术后手部受区外观及功能恢复良好,未见皮瓣臃肿;皮瓣两点辨别觉为7~11 mm,平均8.8 mm。供区直接闭合者术后仅遗留线性瘢痕,供区感觉功能无明显影响。结论游离带感觉神经肋间动脉穿支皮瓣是修复手外伤缺损的较好方法。Objective To investigate the effectiveness of free sensate intercostal artery perforator flap for the hand soft tissue reconstruction.Methods Between March 2010 and September 2015,19 cases of hand soft tissue defect were repaired with free sensate intercostal artery perforator flap,including 16 males and 3 females,aged from 18 to 53 years,with an average of 35.2 years.The defect was located in the dorsum of the hand in 15 cases and in the palm in 4 cases.The causes of injury were traffic accident injury in 8 cases,hot crush injury in 5 cases,strangulation injury in 4 cases,and avulsion injury in 2 cases.All of them were full-thickness skin and soft tissue defects of hand with exposure of phalanges,tendons,blood vessels,and nerves.The size of defect was 10.0 cm×7.0 cm to 17.0 cm×8.0 cm.There were 12 cases of emergency operation and 7 cases of selective operation.The thickness of flap was 10-25 mm,and the size of the flap ranged from 10.0 cm×7.5 cm to 17.0 cm×8.0 cm.The vascular pedicle of the flap was anastomosed with the snuff nest branch of the radial artery(12 cases),the main radial artery(7 cases),and there accompanying vein,and the intercostal nerve cutaneous branch of the flap was anastomosed with the lateral cutaneous nerve of the forearm.The donor site was closed directly(14 cases)or repaired with medium thickness skin graft(5 cases).Results All of the flaps and skin grafts survived;the wounds in the donor and recipient sites healed by first intention.All 19 patients were followed up 10-18 months,with an average of 12.7 months.After operation,the appearance and function of the hand recovered well,and there was no flap bloated.The two-point discrimination of the flap was 7-11 mm,with an average of 8.8 mm.Only linear scars left in the patients with direct closure of the donor site.The sensory function of the donor site was not significantly affected,and the hand function recovered satisfactorily.Conclusion Free sensate intercostal artery perforator flap is a valuable and reliable technique for the hand s

关 键 词：手外伤 游离皮瓣 肋间动脉 穿支皮瓣 感觉重建 

分 类 号：R658.2[医药卫生—外科学]