骨间后动脉Flow-through穿支皮瓣修复伴有指端血运障碍的指背软组织缺损  

Flow-through perforator flap of posterior interosseous artery in repair of dorsal digital soft tissue defect with disorder of blood supply in digital tip

作　　者：周望高 张振伟 余少校 李东扬 陈烨文 叶学浪 熊懿 柯于海 ZHOU Wanggao;ZHANG Zhenwei;YU Shaoxiao;LI Dongyang;CHEN Yewen;YE Xuelang;XIONG Yi;KE Yuhai(Department of Orthopaedics,Shenzhen Hospital of Integrated Traditional and Western Medicine,Shenzhen,Guangdong Province 518104,China)

机构地区：[1]广东省深圳市中西医结合医院骨伤科,广东深圳518104

出　　处：《中华显微外科杂志》2022年第3期284-288,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨骨间后动脉Flow-through穿支皮瓣修复伴有指端血运障碍的指背软组织缺损的临床疗效。方法自2018年1月至2020年6月,对收治的12例伴有指端血运障碍的指背软组织缺损伤的患者采用骨间后动脉Flow-through穿支皮瓣修复,皮瓣面积:2.0 cm×2.0 cm~5.5 cm×3.0 cm,皮瓣内的骨间后动脉桥接指一侧指掌侧固有动脉,皮瓣内的1条皮下静脉和背侧皮下静脉吻合,骨间后动脉的1条伴行静脉和掌侧皮下静脉吻合,供区直接缝合。术后观察伤口愈合情况、指端血运情况及皮瓣成活情况,门诊随访观察皮瓣的成活质量及手指的指骨间关节功能。结果 12例骨间后动脉Flow-through穿支皮瓣全部成活,指端血运良好,伤口均一期愈合。术后随访6~24个月,皮瓣外形及质地良好,无明显臃肿,前臂供区仅留下线状手术瘢痕,手功能恢复按中华医学会手外科学会上肢部分功能评定试用标准评价,结果优11例,良1例。结论骨间后动脉Flow-through穿支皮瓣解剖恒定,血管管径和手指血管匹配,适合操作Flow-through术式,皮下组织少,无需二期修薄,供区能直接闭合,是一种良好修复伴有指端血运障碍指背软组织缺损的治疗方法。Objective To investigate the clinical effect of Flow-through perforator flap of posterior interosseous artery in repair of dorsal digital soft tissue defect with disorder of blood supply in digital tip.Methods From January 2018 to June 2020,12 patients who had digital dorsum soft tissue defect with digital tip blood supply disorder were treated with Flow-through perforator flap of posterior interosseous artery.The size of flaps was 2.0 cm×2.0 cm-5.5 cm×3.0 cm.The posterior interosseous artery in the flap was bridged with the proper palmar artery of digit,1 subcutaneous vein in the flap was anastomosed with the dorsal subcutaneous vein,and 1 subcutaneous vein in the posterior interosseous artery with the palmar subcutaneous vein.The donor sites were sutured directly.The wound healing,blood supply of digit and flap survival were observed after operation.The quality of flap survival and digital joint function were observed in the follow-up reviews at outpatient clinic.Results All the 12 Flow-through perforator flaps of posterior interosseous artery survived,the blood supply of digit was good,and the wounds healed in the first stage.The follow-up period was 6-24 months.The appearance and texture of the flaps were good without obvious bloating.Only linear scar was left in the forearm donor site.According to the Trial Standard of Upper Limb Function Evaluation of Chinese Society of Hand Surgery,the results were excellent in 11 cases and good in 1 case.Conclusion The perforator flap of posterior interosseous artery has constant anatomy,and the diameter of blood vessel matches the blood vessels of digits.It is suitable for Flow-through technique.It has less subcutaneous tissue,no secondary thinning,and the donor site can be closed directly.It is a good method to repair the dorsal soft tissue defect with disorder of digital end blood circulation.

关 键 词：骨间后动脉穿支皮瓣 指背 软组织缺损 修复 血流桥接 

分 类 号：R658.2[医药卫生—外科学]