以横动脉及趾底动脉为蒂的Flowthrough游离皮瓣修复指掌侧软组织缺损  

Application of flowthrough digitorum fibular free skin flap pedicled with thumb transverse artery and basal digitorum artery for repairing soft tissue defect on the palmar side of the fingers

作　　者：周家顺 ZHOU Jiashun(Department of Orthopedics(Reconstructive Microsurgery),Guiyang City Third People's Hospital,Guiyang,Guizhou,550000,China)

机构地区：[1]贵阳市第三人民医院骨科(显微修复重建外科),贵州贵阳550000

出　　处：《实用手外科杂志》2022年第2期148-151,160,共5页Journal of Practical Hand Surgery

摘　　要：目的 探讨应用以横动脉及趾底动脉为蒂的Flowthrough趾腓侧游离皮瓣,急诊修复手指掌侧软组织缺损及重建指端血运的临床疗效。方法 2018年9月-2020年7月,应用以横动脉及趾底动脉为血管蒂的Flowthrough趾腓侧游离皮瓣急诊修复指掌侧皮肤软组织缺损并重建血运11例,趾底动脉与指动脉近端吻合,横动脉与指动脉远端吻合,保留皮瓣横动脉分叉以远趾底动脉主干及血管穿支,趾底固有神经和指固有神经端端或端侧接合。结果 术后11例皮瓣全部成活,无动静脉危象及感染发生,伤口均一期愈合。其中1例因皮瓣下血肿行手术探查血肿清除术,皮瓣成活良好;3例术后半年对外形有更高要求,行皮瓣舒平术。皮瓣供区直接缝合4例,全厚皮片植皮7例,供区切口、植皮区全部一期愈合,无感染及植皮坏死发生。11例获6~21个月随访,未见明显瘢痕形成,足趾活动正常,皮瓣外形逼真,有螺纹,质地良好,两点辨别觉4~8 mm(健侧2~4 mm),行走、跑跳、负重等完全正常。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9例,良2例,优良率100%。结论 以横动脉及趾底动脉为血管蒂的Flowthrough趾腓侧游离皮瓣急诊修复指掌侧皮肤软组织缺损,供区皮瓣血管恒定而且隐蔽,趾跖侧与受区指掌侧外形、质地相近,修复后效果极佳,而且能同时重建手指血运,并接合神经恢复皮瓣感觉,符合受区修复最大化、供区损伤最小化的治疗原则,值得临床推广应用。Objective To design flowthrough free skin flap pedicled with thumb transverse digitorum artery and basal digitorum artery to repair palmar soft tissue defect of finger and reconstruct blood circulation at finger end. Methods From September 2018 to July 2020, flowthrough free skin flap was designed with thumb transverse digitorum artery and basal digitorum artery as vascular pedicle, the basal digitorum artery anastomoses with the proximal end of the digital artery by end-to-end, the thumb transverse artery anastomoses with the distal digital artery by end-to-end. Braches of skin flap thumb transverse artery, distal basal digitorum artery and blood vessels were preserved to repair the palmar soft tissue defect of the finger. At the same time, the blood circulation of the finger end was reconstructed,and the proper basal digitorum nerve and the proper digital nerve were anastomosed end-to-end or end-to-side. With this method, finger defects were repaired and blood circulation were reconstructed in 11 cases. Repairs was completed by direct suture of donor site or full thickness skin grafting. Results All 11 skin flaps survived and all wounds healed in stage Ⅰ, 1 case underwent surgical exploration and hematoma removal due to hematoma under the skin flap after operation, and all cases had no postoperative arteriovenous crisis and postoperative infection. Among them, 3 cases had higher requirements for appearance in six months after operation and underwent skin flap relaxation. The donor site of the flap in 4 cases was sutured directly and was repaired by full thickness skin graft in 7 cases. The incision at the donor site and the skin grafting site all healed in stage I without postoperative infection and skin grafting necrosis. No obvious scar formation was found in the follow-up for half a year after operation. The toe moved normally, the shape was normal, with completely normal shape and the ability of running and jumping, and weight bearing. Eleven cases were followed up for 6 to 21 months. Their skin flaps wer

关 键 词：横动脉 手指掌侧缺损 Flowthrough游离皮瓣 血循环重建 

分 类 号：R658.2[医药卫生—外科学]