以足背为供区的静脉皮瓣修复手背较大面积皮肤软组织缺损  

Clinical application of dorsalis pedis venous flap for repair of large-area skin and soft tissue defects of dorsal hand

作　　者：凌李 李学渊[2] 沈华军 范小龙 左莉红 Ling Li;Li Xueyuan;Shen Huajun;Fan Xiaolong;Zuo Lihong(Department of Hand Surgery,Shaoxing Keqiao District Hospital of Traditional Chinese Medicine,Zhejiang 312030,China;Department of Hand Surgery,Ningbo No.6 Hospital,Zhejiang 315040,China)

机构地区：[1]绍兴市柯桥区中医医院手外科,浙江312030 [2]宁波市第六医院手外科,浙江315040

出　　处：《中华手外科杂志》2020年第3期177-179,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨以足背为供区的静脉皮瓣修复手背较大面积皮肤软组织缺损的可行性及临床效果。方法自2017年1月至2019年1月,我们共收治16例手背软组织缺损患者,缺损面积为2.0 cm×4.0 cm^4.0 cm×8.0 cm。其中2例清洁伤口急诊行皮瓣修复;余14例行急诊一期负压吸引,一周后创面清洁行二期足背超薄静脉皮瓣附带足背神经游离修复。供区直接缝合或植皮修复。术后观察皮瓣存活情况,2周后开始功能锻炼。结果本组术后均获得随访,时间为6~12个月,平均9个月,13例顺利存活,3例部分坏死,经换药后愈合。除3例皮瓣部分瘢痕愈合外,其余皮瓣外观平滑,无臃肿。13例患手掌指关节屈曲达到90°~100°,3例为50°~65°。仅2例患侧腕关节活动较健侧差,约受限10°~20°,其余与健侧相比无明显差别。结论应用足背静脉动脉化皮瓣修复手背较大面积皮肤软组织缺损是可靠的修复方案之一,避免了传统皮瓣外观臃肿现象,能够满足手背所需的皮肤弹性。Objective To explore the feasibility and clinical efficacy of dorsalis pedis venous flap for repair of large-area skin and soft tissue defects of dorsal hand.Methods From January 2017 to January 2019, 16 patients with soft tissue defects of dorsal hand were treated. The defect area ranged from 2.0 cm×4.0 cm to 4.0 cm×8.0 cm. Among them, 2 cases were treated with skin flap in emergency. The other 14 cases were treated with vacuum sealing drainage in the first stage, and one week later, the wounds were cleaned and repaired by free ultra-thin dorsalis pedis venous flap with dorsalis pedis nerve. The donor area was directly sutured or repaired by skin grafting. The survival of flap was observed after operation, and functional exercise was started and followed up 2 weeks later.Results All the patients were follow-up for 6 to 12 months with an average of 9 months.13 cases survived uneventfully, and 3 cases were partially necrotic and healed after dressing change. Except for 3 cases of partial scar healing, the appearance of other flaps was smooth without bulking. The flexion of the affected metacarpophalangeal joints was 90° to 100° in 13 cases and 50° to 65° in 3 cases. Only two patients had poor affected wrist movement compared with the healthy side, which was limited by 10° to 20°. The rest had no significant difference compared with the healthy side.Conclusion It is one of the reliable methods to repair the large-area skin and soft tissue defects of dorsal hand with arterialized dorsalis pedis venous flap, which can avoid the appearance bulky phenomenon of the traditional flap and also meet the skin elasticity required by the dorsal hand.

关 键 词：手损伤 外科皮瓣 静脉动脉化 缺损 

分 类 号：R658.2[医药卫生—外科学]