第1跖背-趾背动脉皮瓣修复手指掌侧大面积软组织缺损  

First dorsal metatarsal-dorsal phalangeal artery flap in repairing large area of soft tissue defect on the palmar side of finger

作　　者：吕文涛[1] 巨积辉[1] 蒋国栋[1] 唐晓强 张庆阳 王免 王晓松 LYU Wentao;JU Jihui;JIANG Guodong;TANG Xiaoqiang;ZHANG Qingyang;WANG Mian;WANG Xiaosong(Department of Hand Surgery,Ruihua Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province 215104,China)

机构地区：[1]苏州大学附属瑞华医院手外科,江苏苏州215104

出　　处：《中华显微外科杂志》2021年第1期20-23,共4页Chinese Journal of Microsurgery

基　　金：江苏省第五期"333工程"培养资金资助项目(BRA2017068);江苏省青年医学人才项目(QNRC2016224)。

摘　　要：目的探讨应用第1跖背-趾背动脉皮瓣修复手指掌侧大面积软组织缺损的临床疗效。方法自2016年2月至2018年6月,设计应用第1跖背-趾背动脉皮瓣修复手指掌侧大面积软组织缺损11例11指,其中男7例,女4例;年龄19~46岁,平均32.5岁;3例采用第1跖背-第1趾背动脉供血,8例采用第1跖背-第2趾背动脉供血;对3例指腹创面残留的患指修复创面同时桥接了指掌侧固有动脉;其中1例合并屈肌腱缺损切取皮瓣时携带第2趾趾短伸肌腱。术前应用CDU探测血管类型为Gilbert I型,皮瓣面积为1.5 cm×5.0 cm~3.0 cm×8.0 cm,供区采用小腿全厚皮片加压植皮。随访资料来自门诊复诊及电话随访。结果本组11例皮瓣全部成活;术后均获得随访,时间为6~24个月,平均14个月。皮瓣色泽、质地好,温、痛、触觉恢复,外形不臃肿,手指功能恢复良好,远、近侧指骨间关节活动度均接近正常,皮瓣TPD为5~11 mm,平均8 mm。足部供区创面I期愈合10例,1例植皮近趾蹼处坏死,经换药后愈合。远期随访植皮区耐磨,不妨碍行走,无破溃发生。结论应用第1跖背-趾背动脉皮瓣修复手指掌侧大面积软组织缺损,具有覆盖创面的同时可携带肌腱、可桥接指掌侧固有动脉等优点,疗效满意。Objective To investigate the clinical effect of the first dorsal metatarsal-dorsal phalangeal artery flap in repairing large area of soft tissue defect on the palmar side of finger.Methods From February,2016 to June,2018,11 fingers of 11 patients(7 males and 4 females,aged 19-46 years old with an average of 32.5 years old)with large area of soft tissue defect on the palmar side of the finger were repaired with the first dorsal metatarsal-dorsal phalangeal artery flap.These included 3 with the first dorsal metatarsal-first dorsal phalangeal artery blood supply,and 8 with the first dorsal metatarsal-second dorsal phalangeal artery blood supply.In which 3 with retained finger pulp was for repairing the defects and bridging arteries,including 1 flexor tendon defect repaired by the extensor digitorum brevis tendon of the second toe with the flap.The type of blood vessel was Gilbert I detected by CDU before surgery.The area of the flaps was from 1.5 cm×5.0 cm to 3.0 cm×8.0 cm.The donor area of the flaps was compressed with full thickness skin grafts of the shank.The follow-up data was collected by outpatient clinic visits and telephone interviews.Results All the 11 flaps survived and were followed-up for an average of 14 months,ranged from 6 months to 24 months.The colour and texture of the flaps were good.Sensing of temperature,pain and touch restored,without swelling.Function of the fingers was well restored.The range of motion of distal and proximal interphalangeal joints was closed to normal.The TPD of the flaps was 5-11 mm,with an average of 8 mm.Ten had primary wound healing in the donor sites of foot.One case had necrosis of the proximal toe of the skin graft and healed after dressing change.Long-term follow-up of the skin grafting area was wear-resistant,and does not hinder walking without rupture.Conclusion Application of the first dorsal metatarsal-dorsal toe artery flap to repair large area of soft tissue defect on the palmar side of finger has number of advantages such as it,covers the wound and carry the

关 键 词：第1跖背动脉 趾背动脉 外科皮瓣 手指 指软组织缺损 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]