游离指掌侧固有动脉近节穿支皮瓣修复手指指端软组织缺损  

Repair of digit tip soft tissue defect with free proximal perforator flap of proper palmar digital artery

作　　者：侯桥[1] 刘玲芬[2] 洪生虎 任国华[1] 杨军[1] 庄伟[1] 瞿钢 全仁夫[1] HOU Qiao;LIU Lingfen;HONG Shenghu;REN Guohua;YANG Jun;ZHUANG Wei;QU Gang;QUAN Renfu(Medical Community General Hospital of Traditional Chinese Medicine Hospital of Xiaoshan District,Hangzhou City 311200,China;Chengxiang Branch of Medical Community General Hospital of Traditional Chinese Medicine Hospital of Xiaoshan District,Hangzhou City 311201,China)

机构地区：[1]杭州市萧山区中医院医共体总院,311200 [2]杭州市萧山区中医院医共体总院城厢分院,311201

出　　处：《中华显微外科杂志》2021年第5期503-506,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨应用游离指掌侧固有动脉近节穿支皮瓣修复手指指端软组织缺损的手术方法及治疗效果。方法2009年3月至2021年1月,对15例16指指端软组织缺损的患者,采用游离指掌侧固有动脉近节穿支皮瓣进行修复,皮瓣在示指尺侧、中指两侧、环指桡侧近节侧方设计切取,切取面积1.8 cm×1.2 cm~4.5 cm×2.2 cm,皮瓣内携带指掌侧固有神经背侧支及0.5~4.5 cm的指掌侧固有动脉主干,皮瓣切取后,供区指掌侧固有动脉再重新吻合者3例3指,移植吻合者2例2指,不吻合者10例11指,将皮瓣内携带的指掌侧固有神经背侧支与受区手指残端的指掌侧固有神经缝接,恢复皮瓣的感觉,供区均切取腕横纹或肘横纹处皮肤植皮关闭。术后定期门诊、电话或微信随访,观察患者皮瓣外观、感觉及手指关节功能恢复情况。结果术后15例16指皮瓣及供区植皮全部成活,伤口一期愈合,术后随访4个月~12年,皮瓣质地优良,外形饱满,TPD达7~11 mm,手指关节功能均恢复良好,未主诉供区感觉不适。按照Michigan手部功能问卷评定标准,15例患者对手部整体外观及功能非常满意。手指活动度按照TAM评定标准,15例均为优。结论指掌侧固有动脉近节穿支游离皮瓣血管解剖恒定,供区隐蔽、创伤小,皮瓣切取简单,效果好,是修复指端软组织缺损的一种理想的方法。Objective To explore the surgical method and therapeutic effect of repairing digital tip defect with free flap of proximal perforating branch of proper palmar digital artery.Methods From March,2009 to January,2021,15 patients with soft tissue defects at the tip of 16 digits were repaired with free perforator flap of proper palmar digital artery.The flap was obtained from the ulnar side of an index finger,on both sides of a middle finger and on the proximal side of the radial side of the ring finger.The size of flaps was 1.8 cm×1.2 cm-4.5 cm×2.2 cm.The flap carried dorsal branch of proper palmar digital nerve and 0.5-4.5 cm of arteriae digitales palmares propriae.The donor digital artery was re-anastomosed in 3 cases 3 digits,transferred and anastomosed in 2 cases and un-anastomosed in 10 cases 11 digits.The dorsal branch of the proper palmar digital nerve in the flap was anastomosed with the proper palmar digital nerve of the finger stump at the recipient site to restore the sensation of flap,and the donor sites at the wrist transverse stripes or elbow transverse stripes were directly sutured.Regular follow-up via outpatient visit,telephone or WeChat interviews was conducted to observe the appearance,sensation and recovery of the flap and finger joint function.Results After surgery,the flaps and donor site skin grafts of 15 cases with 16 digits were all survived,with first stage healing.A 4 months to 12 years follow-up showed that the flaps were in good texture and full shape with TPD at 7-11 mm.The joint function of digits was recovered well,and there was no complaint about uncomfortable donor site.According to the Michigan Hand Function Questionnaire,all 15 patients were satisfied with the overall appearance and function of the hands.According to TAM evaluation standard,all the digits of 15 patients were in excellent.Conclusion Free flap of the proximal perforating branch of proper palmar digital artery is an ideal in the repair of digital tip soft tissue defect,as it has the advantages of an anatomical const

关 键 词：指掌侧固有动脉 穿支皮瓣 指损伤 修复 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]