手和足部创面修复时四种吻合血管的皮神经营养血管穿支皮瓣的选择  

Selection of 4 kinds of neurocutaneous perforator flap with vascular anastomosis for repair of hand and foot wounds

作　　者：徐永清[1] 何晓清 陈雪松[2] 范新宇 梅良斌[1] 董凯旋 崔轶[1] 朱跃良[1] 李军[1] 蔡兴博 李霞[1] XU Yongqing;HE Xiaoqing;CHEN Xuesong;FAN Xingyu;MEI Liangbing;DONG Kaixuan;CUI Yi;ZHU Yueliang;LI Jun;CAI Xingbo;LI Xia(Institute of Orthopaedic Trauma,920th Hospital of the PLA Joint Logistic Support Force,Kunming 650032,China;Department of Orthopaedic Trauma,926th Hospital of the PLA Joint Logistic Support Force,Kaiyuan,Yunnan Province 661600,China)

机构地区：[1]中国人民解放军联勤保障部队第920医院全军创伤骨科研究所,昆明650032 [2]中国人民解放军联勤保障部队第926医院创伤骨科,云南开远661600

出　　处：《中华显微外科杂志》2020年第4期331-337,共7页Chinese Journal of Microsurgery

基　　金：云南省创伤骨科临床医学中心(建设单位)(ZX20191001);云南省钟世镇院士工作站(2015IC030);全军后勤科研计划面上项目(CCD14J003)。

摘　　要：目的比较4种吻合血管的皮神经营养血管穿支皮瓣修复手、足部创面的临床效果。方法2005年1月至2019年9月,收治手、足创面患者共112例,其中手指78例,虎口11例,手掌5例,手背6例,足部12例;软组织缺损面积2.0 cm×1.5 cm^21.0 cm×12.0 cm;均采用吻合血管的皮神经营养血管穿支皮瓣修复。应用皮瓣种类:桡侧副动脉穿支皮瓣(带前臂后侧皮神经)30例,皮瓣面积5.0 cm×2.0 cm^13.0 cm×6.0 cm;吻合血管的腓浅动脉穿支皮瓣(未带腓浅神经)15例,皮瓣面积2.5 cm×2.0 cm^9.0 cm×6.0 cm,修复手背、虎口、手掌及手指创面;腓肠外侧浅动脉穿支皮瓣(带腓肠外侧皮神经上段)26例,皮瓣面积2.5 cm×1.8 cm^7.0 cm×5.0 cm,修复手背、虎口、手掌及手指创面;腓动脉穿支皮瓣(带腓肠神经中下段)41例,皮瓣面积2.5 cm×1.8 cm^23.0 cm×14.0 cm,修复足部、手背、虎口、手掌及手指创面。其中40例做CTA的观察,分别测量桡侧副动脉、腓浅动脉、腓肠外侧浅动脉、腓动脉的出现率和起始处血管口径。缝接皮神经97例,未缝接皮神经15例(均为腓浅动脉穿支皮瓣)。术后定期随访。结果切取腓动脉穿支皮瓣(41例)、桡侧副动脉穿支皮瓣(30例),两种皮瓣穿支出现率是100%;腓肠外侧浅动脉出现率为80.0%,穿支利用率为80.8%(21/26),有19.2%(5/26)因血管太细改为腓肠内侧浅动脉;腓浅动脉穿支出现率为90.0%,可利用率为60.0%(9/15),其中40.0%(6/15)改为腓动脉穿支皮瓣。除1例腓肠外侧浅动脉穿支皮瓣远端部分坏死,经换药愈合外,其余皮瓣全部成活。有101例获得随访,其中修复手部软组织缺损90例,修复足部软组织缺损11例,随访时间12~120个月,平均36.6个月。修复手部者功能优40例,良45例,可5例。缝接手部皮瓣皮神经者78例,感觉功能均达到S3级以上;未缝接手部皮瓣皮神经者12例,感觉功能达到S3级3例、S2级9例;修复足部软组织缺损11例均缝接了皮神经,感觉功能均Objective To compare the clinical effects of 4 kinds of neurocutaneous perforator flap with vascular anastomosis for repair of hand and foot wounds.Methods From January,2005 to September,2019,112 patients with hand and foot wounds were treated,there were 78 cases of fingers,11 cases of first web,5 cases of palm,6 cases of hand and 12 cases of foot.The defect area was 2.0 cm×1.5 cm-21.0 cm×12.0 cm.All 112 cases were repaired by neurocutaneous perforator flaps anastomosed with blood vessels.Types of flap were applied:Radial collateral artery perforator flap(with posterior cutaneous nerve of forearm)in 30 cases.The flap area was 5.0 cm×2.0 cm-13.0 cm×6.0 cm.Superficial peroneal artery flap(without superficial peroneal nerve)anastomosed with blood vessels in 15 cases.The flap area was 2.5 cm×2.0 cm-9.0 cm×6.0 cm.Lateral superficial sural artery perforator flap(with superior sural cutaneous nerve)in 26 cases.The flap area was 2.5 cm×1.8 cm-7.0 cm×5.0 cm.Peroneal artery perforator flap(with middle and lower sural nerve)in 41 cases.The flap was harvested with area of 2.5 cm×1.8 cm-23.0 cm×14.0 cm to repair the wounds of feet,back of hands,first web,palm and fingers.CTA images were observed in 40 clinical patients,and the occurrence rate of radial collateral artery,superficial peroneal artery,superficial lateral sural artery,and peroneal artery were measured.Anastomosis cutaneous nerve in 97 cases,and no cutaneous nerve anastomosis 15 cases(superficial peroneal artery flap).Results The peroneal artery perforator flap(41 cases)and radial collateral artery perforator flap(30 cases)were harvested.The incidence of perforator vessels was both 100%,and incidence of superficial sural artery was 80.8%(21/26 cases).In the other 19.2%(5/26 cases),the superficial medial sural artery was replaced by too thin vessels.The utilization rate of superficial peroneal artery was 60.0%(9/15 cases),the other 40.0%(6/15 cases)were converted to peroneal artery perforator flap.All flaps survived except 1 case of superficial perforator

关 键 词：皮神经营养血管穿支皮瓣 腓浅动脉穿支 桡侧副动脉穿支 腓肠外侧浅动脉穿支 腓动脉穿支 血管吻合 修复 

分 类 号：R658[医药卫生—外科学]