旋转点下移的前臂逆行骨间后动脉穿支皮瓣的临床应用  

Clinical application of forearm reverse posterior interosseous artery perforator flap with downward rotation point

作　　者：张凯 杨涛 熊颖杰 陈佳 仓飞成 邵留影 周明武 幸超峰 Zhang Kai;Yang Tao;Xiong Yingjie;Chen Jia;Cang Feicheng;Shao Liuying;Zhou Mingwu;Xing Chaofeng(Department of Orthopedics,No.988 Hospital of PLA Joint Logistics Support Force,Zhengzhou 450042,China)

机构地区：[1]解放军联勤保障部队第九八八医院全军创伤骨科中心,郑州450042

出　　处：《中华手外科杂志》2021年第4期251-254,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨旋转点下移的前臂逆行骨间后动脉穿支皮瓣修复手部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6月,我们采用旋转点下移的前臂逆行骨间后动脉穿支皮瓣修复手部皮肤软组织缺损患者16例。一期修复12例,二期修复4例。手掌背侧7例,虎口部7例,手指背侧2例。缺损面积为4.0 cm×3.0 cm~9.5 cm×6.0 cm。皮瓣供区直接拉拢缝合或采用全厚皮片移植修复结果术后16例皮瓣均存活,其中15例伤口I期愈合,1例皮瓣术后发生静脉危象,拆除缝线积极处理,经加强换药最终存活。术后均获得随访,时间为6〜18个月,平均13个月,皮瓣外形不臃肿,质地良好,无明显色素沉着,供受区功能恢复良好。结论旋转点下移的前臂逆行骨间后动脉穿支皮瓣血供可靠,操作相对简便,可修复手部远端创面,同时降低骨间后神经损伤的手术风险,减少供区损害,有一定的临床应用价值。Objective To explore the feasibility and clinical efficacy of forearm reverse posterior interosseous artery perforator flap with downward rotation point for repair of hand skin an soft tissue defects.Methods From January 2017 to June 2019,16 patients with hand skin and soft tissue defects were treated with forearm reverse posterior interosseous artery perforator flap with downward rotation point.There were 12 cases of primary repair and 4 cases of secondary repair.There were 7 cases on the dorsal side of palm,7 cases on the first web of hand and 2 cases on the dorsal side of finger.The defect area ranged from 4.0 cm×3.0 cm to 9.5 cm×6.0 cm.The donor site of flap was sutured directly or repaired with full-thickness skin graft.Results All the 16 flaps survived,including 15 cases with primary wound healing and 1 case with venous crisis after operation which was treated actively by removing sutures and finally survived after intensive dressing change.All the patients were follow-up for 6 to 18 months with an average of 13 months.The skin flaps were not bulky in appearance with good texture,and without obvious pigmentation.The function of donor and recipient area recovered well.Conclusion The forearm reverse posterior interosseous artery perforator flap with downward rotation point has reliable blood supply with relatively simple operation.It can repair the distal wound of hand,reduce the operation risk of posterior interosseous nerve injury and donor site damage.It has certain clinical application value.

关 键 词：外科皮瓣 手损伤 骨间后动脉 旋转点 软组织缺损 

分 类 号：R658.2[医药卫生—外科学]