游离腕横纹皮瓣结合皮神经移植修复手指"C"形软组织缺损  

Reconstruction of finger C-shape soft tissue defect with wrist crease free flap carrying cutaneous nerve

作　　者：刘家寅[1] 孙汝涛[1] 刘会仁[1] 于占勇[1] 王岩[1] 窦淑萍[1] 吴学强[1] 郭益玮 LIU Jiayin;SUN Rutao;LIU Huiren;YU Zhanyong;WANG Yan;DOU Shuping;WU Xueqiang;GUO Yiwei(Department of Hand Surgery,The Second Hospital of Tangshan,Tangshan,Hebei Province 063000,China)

机构地区：[1]唐山市第二医院手外科,河北唐山063000

出　　处：《中华显微外科杂志》2021年第6期604-608,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨携带皮神经的游离腕横纹皮瓣修复手指"C"形软组织缺损的手术方法及临床效果。方法自2017年6月至2019年4月,采用携带皮神经的游离腕横纹皮瓣治疗手指"C"形软组织缺损7例,软组织缺损大小1.0 cm×2.5 cm~2.2 cm×4.0 cm,皮瓣切取面积1.3 cm×2.7 cm~2.5 cm×4.5 cm。单侧指掌侧固有动脉缺损5例,双侧指掌侧固有动脉缺损伴手指血运障碍2例,应用Flow-through皮瓣重建手指血运;4例单侧指掌侧固有神经缺损,3例双侧指掌侧固有神经缺损,应用桡神经浅支修复5例,正中神经掌皮支修复2例。出院后定期门诊随访。结果本组7例术后皮瓣及患指均顺利成活,创面及供区切口一期愈合。所有患者均获随访,随访时间为8~15个月,平均11个月。皮瓣色泽正常,外形无臃肿,质地柔软,保护性感觉恢复。指端感觉恢复:5例为S_(4),2例为S_(3)^(+)。指体无萎缩,指骨间关节屈、伸活动自如。供区除遗留线样瘢痕外,腕关节活动自如,无功能影响。按中华医学会手外科学会上肢部分功能评定试用标准评定:优6例,良1例。结论携带皮神经的游离腕横纹皮瓣解剖恒定,切取方便,横向切取适合修复手指"C"形软组织缺损,可同时重建血运及感觉。Objective To explore clinical results in reconstruction of finger C-shape soft tissue defect with the wrist crease free flap carrying cutaneous nerve.Methods From June,2017 to April,2019,7 fingers(7 patients)with C-shape defect were treated with the wrist crease free flap carrying cutaneous nerve.The size of defect ranged from 1.0 cm×2.5 cm-2.2 cm×4.0 cm;the flap sizes were 1.3 cm×2.7 cm-2.5 cm×4.5 cm.Five fingers had unilateral defect of proper palmar digital artery.Two fingers that had bilateral defect of proper palmar digital artery with poor blood circulation were re-established with blood supply by Flow-through flaps.Four fingers had unilateral defect of proper palmar digital nerves,and 3 had bilateral defect of proper palmar digital artery.Five of the fingers were repaired by the superficial branch of the radial nerve and 2 repaired by palmar cutaneous branch of median nerve.Regular outpatient follow-up was conducted after surgery for 8 to 15(mean 11)months.Results All the fingers and flaps survived with primary healing.Numbness existed in the areas of functional dominance of the cutaneous nerve.At the end of follow-up,the flaps showed good texture without significant bloated appearance with the recovery of protective sensation.The sensation of fingertip recovered to S_(4) in 5 fingers and S_(3)^(+)in 2 fingers.Finger pulps were plump.All of the fingers moved freely.Linear scars were observed at donor sites and the wrists moved freely.Numbness feeling in the areas of cutaneous nerve disappeared at 6 to 8 weeks after surgery.According to the Functional Evaluation Criteria of the Finger Replantation published by the Hand Surgery Society of the Chinese Medical Association,the results were excellent in 6 fingers and good in 1 finger.Conclusion The wrist crease free flap carrying cutaneous nerve is constant and can be dissected transversely to reconstruct and fit the C-shape defect of finger.It can re-establish the blood supply as well as to repair the proper palmar digital nerve defect at the same time.

关 键 词：腕横纹皮瓣 皮神经 手指 软组织缺损 

分 类 号：R658.2[医药卫生—外科学]