第1跖背动脉-第2趾胫侧动脉一蒂串联皮瓣修复同手指两处软组织缺损  

Repair of two soft tissue defects on the same finger by a pedicled tandem flap with first dorsal metatarsal artery-second toe tibial artery in series

作　　者：李木卫 吴巩 黄少耿 张喆 马立峰 杨延军 张子清 LI Muwei;WU Gong;HUANG Shaogeng;ZHANG Zhe;MA Lifeng;YANG Yanjun;ZHANG Ziqing(Department of Hand Microsurgery and Vascular Surgery,The Long Gang Orthopaedics Hospital of Shenzhen,Shenzhen,Guangdong Province 518116,China)

机构地区：[1]深圳市龙岗区骨科医院手显微血管外科,广东深圳518116

出　　处：《中华显微外科杂志》2021年第4期374-377,共4页Chinese Journal of Microsurgery

基　　金：深圳市龙岗区医疗卫生科技计划项目(LGKCYLWS2019000820)。

摘　　要：目的探讨以第1跖背动脉-第2趾胫侧动脉一蒂串联皮瓣修复同一手指两处软组织缺损的方法及临床疗效。方法2018年3月-2020年5月,采用第1跖背动脉-第2趾胫侧串联皮瓣修复同一手指两处软组织缺损创面8例。致伤原因:挤压伤4例,重物砸伤2例,热压伤2例。患指位于示指4例,中指2例,环指2例。缺损范围2.0 cm×2.5 cm~2.5 cm×3.0 cm;均有不同程度骨或肌腱外露,伴指骨骨折3例。急诊手术3例,亚急诊手术5例,于伤后3~5 d进行。切取皮瓣范围2.0 cm×2.5 cm~3.0 cm×3.5 cm;供区直接缝合3例,植皮5例。术后定期随访,观察皮瓣成活情况、质地、感觉及关节自主活动度(TAM),及足部供区恢复情况、是否出现并发症。结果本组手术时间为2.0~5.5 h,平均3.5 h;术后未出现血管危象,皮瓣全部成活。8例患者获随访3~20(平均8)个月:皮瓣外观饱满,质地柔软,弹性良好,与周围组织相似度高,皮瓣TPD为6~15 mm,平均8 mm;手指屈、伸功能良好;足部供区切口I期愈合,行走及跑跳正常,无疼痛不适。结论应用第1跖背动脉-第2趾胫侧动脉串联皮瓣修复同手指两处软组织缺损,简化皮瓣血运重建,手术效果确切,是一种可供选择的修复方法。Objective To investigate the technique and clinical effect of repairing 2 soft tissue defects on the same finger with a pedicled tandem flap of the first dorsal metatarsal artery and the second toe tibial artery.Methods From March,2018 to May,2020,8 patients,which were 5 males and 3 females,with 2 soft tissue defects in the same finger,were repaired with the first dorsal metatarsal artery flap in series with the second toe tibial flap.The causes of injury:4 by crush,2 by heavy object,and 2 by thermal press.There were 4 defects on index fingers,2 on middle fingers and 2 on ring fingers.The defects ranged from 2.0 cm×2.5 cm to 2.5 cm×3.0 cm.All defects had exposed bone or tendon at varying degrees and 3 with phalanx fractures.Three patients underwent emergency surgery,the other 5 had sub-emergency surgery which were performed 3 to 5 days after the injury.The size of the flaps was 2.0 cm×2.5 cm to 3.0 cm×3.5 cm.The donor sites were sutured directly in 3 patients and 5 patients received skin grafting.The regular follow-up was performed.The survival of flaps,character,feeling and Total active motion(TAM),recovery of the foot donor area and complications were observed.Results The operation time ranged from 2.0 to 5.5 hours,with an average of 3.5 hours.No vascular crisis occurred and all flaps survived after the surgery.All patients entered follow-up for 3-20 months,with an average of 8 months.The flaps had a good plump appearance,soft texture,good e-lasticity,and with a high similarity to the surrounding skin.The TPD of the flaps was 6-15 mm,with an average of 8 mm.The fingers had good flexion and extension functions.The incision in the donor site of the foot healed by first intention.The walking,running and jumping were normal without pain or discomfort.Conclusion The first dorsal metatarsal artery-second toe tibial artery tandem flap has been used to repair 2 soft tissue defects in same finger.It simplifies the revascularisation of the flap together with exact surgical curative effect.

关 键 词：串联皮瓣 第1跖背动脉 第2趾胫侧动脉 手指 软组织缺损 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]