吻合血管的第二掌背动脉皮瓣修复手指掌侧皮肤伴双侧指固有神经、动脉缺损  

Application of the second dorsal metacarpal artery flap with vascular anastomosis for repair of the digital palmar skin defects with bilateral proper digital nerve and artery defects

作　　者：杨焕友[1] 王斌[1] 李瑞国[1] 王伟[1] 张荐[1] Yang Huanyou;Wang Bin;Li Ruiguo;Wang Wei;Zhang Jian(Department of Hand Surgery,the Second Hospital of Tangshan,Heibei 063000,China)

机构地区：[1]唐山市第二医院手外科,河北063000

出　　处：《中华手外科杂志》2021年第1期10-12,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨吻合血管的第二掌背动脉(second dorsal metacarpal artery,SDMA)皮瓣修复手指掌侧皮肤伴双侧指固有神经、动脉缺损的手术方法及临床疗效。方法自2017年2月至2019年3月,我们对11例手指掌侧皮肤伴双侧指固有神经、动脉缺损患者采用SDMA皮瓣修复创面,皮瓣近端切断的SDMA与创面远端的指固有动脉吻合,取手背橈神经浅支桥接修复指固有神经,重建手指末梢血运及感觉。结果术后11例患者均获得随访,时间为10-18个月,平均16个月,1例皮瓣边缘部分坏死,经换药后愈合,其余皮瓣均顺利存活,术后皮瓣外观、质地良好。伤指末梢血运好,指腹的温度、颜色与周围皮肤基本一致。指腹皮肤两点分辨觉为7-10 mm,平均8.8 mm。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手功能:优9例,良2例。结论应用吻合血管的SDMA皮瓣及神经移植修复手指掌侧皮肤伴指固有动脉、神经缺损,在一期修复手指缺损创面的同时重建患指末梢血运及感觉,临床疗效满意,是一种较好的修复方法。Objective To explore the surgical method and clinical efficacy of the second dorsal metacarpal artery(SDMA)flap with vascular anastomosis for repair of the digital palmar skin defects with bilateral proper digital nerve and artery defects.Methods From February 2017 to March 2019,11 cases of the digital palmar skin defects with bilateral proper digital nerve and artery defects were repaired by the SDMA flap.The SDMA cut at the proximal end of the flap was anastomosed with the digital proper artery at the distal end of the wound.The superficial branch of radial nerve of the dorsal hand was used to bridge the proper digital nerve,and the blood supply and sensation of the fingertip were reconstructed.Results All the 11 patients were followup for 10 to 18 months with an average of 16 months.One case had partial necrosis of the flap edge and healed after dressing change.The other flaps survived uneventfully.The appearance and texture of the flaps were good.The temperature and color of the pulp of the injured finger were consistent with the surrounding skin.The two-point discrimination of finger pulp skin was 7 to 10 mm with an average of 8.8 mm.According to the evaluation standard of upper limb function of the Society of Hand Surgery of Chinese Medical Association,9 cases were excellent and 2 cases were good.Conclusion The SDMA flap with vascular anastomosis can used to repair the digital palmar skin defects with bilateral proper digital nerve and artery defects.The primary repair of finger defects and reconstruction of peripheral blood supply and sensation of the affected finger were satisfactory.It is a good repair method.

关 键 词：指损伤 外科皮瓣 第二掌背动脉 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]