游离臂内侧穿支皮瓣修复手指脱套伤后软组织缺损  

Repair of soft tissue defect after digit degloving injury with free medial perforator flap of arm

作　　者：胡富华 陈亚萍 侯桥 姚平[1] HU Fuhua;CHEN Yaping;HOU Qiao;YAO Ping(Department of Plastic Surgery,Hangzhou Plastic Surgery Hospital,Hangzhou 310000,China;Hand Surgery Department,Jiangnan Hospital Affiliated to Binjiang College,Zhejiang University of Traditional Chinese Medicine,Hangzhou 311200,China)

机构地区：[1]杭州整形医院整形美容科,杭州310000 [2]浙江中医药大学滨江学院附属江南医院手外科,杭州311200

出　　处：《中华显微外科杂志》2022年第2期152-156,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨应用游离臂内侧穿支皮瓣修复手指脱套伤后软组织缺损的手术方法和治疗效果。方法自2009年10月至2020年12月,对15例手指软组织脱套缺损的患者采用游离臂内侧穿支皮瓣进行修复,其中男9例,女6例;年龄22~50岁,平均32岁;受伤机制:机器绞伤13例,机器压伤2例;脱套平面:自拇指掌指关节以远2例,自第2~5指单个手指中末节4例,自第2~5指掌指关节以远全手指脱套9例;左手7例,右手8例;急诊手术2例,择期手术13例。将皮瓣设计成长条形,皮瓣切取面积5.0 cm×2.5 cm~14.0 cm×3.5 cm。术中将皮瓣的动脉血管蒂与受区手指的指掌侧固有动脉或者指总动脉做吻合,皮下静脉或动脉的伴行静脉与指背或指掌侧皮下静脉做吻合,皮瓣内携带的臂内侧皮神经与指掌侧固有神经残端做缝接。供区均直接拉拢缝合。术后定期门诊、电话、微信或上门随访,观察皮瓣外观、感觉及手指关节功能恢复情况,同时调查患者满意度。结果术后皮瓣全部顺利成活。6例全手指脱套缺损的患者因末节指骨坏死,伤口愈合不佳,二期行残端修整术保留手指至中节远端。2例拇指及2例中指在术后7~9个月时发生过烫伤及磨破,结痂后自愈。术后随访6~28(平均16)个月;皮瓣无臃肿,质地柔软,感觉恢复至S2~S3;手指外形较好,无一例需二期皮瓣整形,但是指骨间关节总体活动尚好,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;供区线形瘢痕隐蔽,无触压痛及挛缩等并发症。结论游离臂内侧穿支皮瓣修复手指脱套伤后软组织缺损,皮瓣设计容易、质地薄,术后手指外形不臃肿,是修复手指套状缺损一种较好的方法。Objective To explore the surgical technique and therapeutic effect of flap wrapping repair of soft tissue defect after digit degloving injury with free arm medial perforator flap.Methods From October 2009 to December 2020,15 patients with soft tissue defect after digit degloving injury were repaired with free arm medial perforator flaps.The patients were 9 males and 6 females aged 22 to 50 years old,with an average of 32 years old.Injury mechanism:13 cases of machine strangulation and 2 cases of machine crushing.Plane of sleeve avulsion injury:at the distal metacarpophalangeal joint of thumb in 2 cases,at the middle and distal segment of single finger of 2nd to 5th fingers in 4 cases,and at distal metacarpophalangeal joint of 2nd to 5th fingers in 9 cases.Seven cases were in left hand and 8 in right hand.Emergency surgery was performed in 2 cases and scheduled surgery in 13 cases.The flap was designed in a shape of a long strip,and the size of the flap was 5.0 cm×2.5 cm-14.0 cm×3.5 cm.During the operation,the artery of the flap pedicle was anastomosed with the palmar digital proper artery or common digital artery of the recipient digit,the subcutaneous vein or the companion vein of the artery was anastomosed with the dorsal or palmar digital subcutaneous vein,and the medial brachial cutaneous nerve carried in the flap was anastomosed with the stump of palmar digital proper nerve.All the donor sites were directly sutured.After the surgery,follow-up visits were conducted regularly at outpatient clinic,or via telephone and WeChat review or by home visit.The flap appearance,sensation and function recovery of digital joints were observed together with the patient satisfaction.Results All flaps survived successfully after surgery.Six patients with degloving defect of the whole digit had encountered poor wound healing caused by distal phalangeal necrosis.The second stage stump trimming was performed to keep the digit to the distal end of the middle segment.Two cases of thumb and 2 cases of middle finger suffered furth

关 键 词：指 脱套伤 臂内侧穿支皮瓣 显微外科技术 

分 类 号：R658.2[医药卫生—外科学]