动脉分流调节前负荷在游离穿支皮瓣修复手部软组织缺损术中的应用  

Application of arterial shunt regulating preload in repair of hand soft tissue defect with free perforator flap

作　　者：陈烨文 周望高 张振伟 李征 余少校 李东扬 林慧鑫 柯于海 Chen Yewen;Zhou Wanggao;Zhang Zhenwei;Li Zheng;Yu Shaoxiao;Li Dongyang;Lin Huixin;Ke Yuhai(Department of Hand Surgery,Shenzhen Shajing Hospital Affiliated to Guangzhou Medical University,Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine,Shenzhen 518104,China)

机构地区：[1]广州医科大学附属深圳沙井医院(深圳市中西医结合医院)手外科,深圳518104

出　　处：《中华手外科杂志》2022年第2期107-110,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨游离穿支皮瓣通过动脉分流调节前负荷修复手部软组织缺损的临床疗效。方法自2016年1月至2020年4月我科采用游离穿支皮瓣修复手部皮肤软组织缺损患者36例,术中通过动脉分流调节前负荷。采用Flow-through方式分流16例,采用吻合主干动脉分支分流12例,动脉端侧吻合分流8例。其中旋股外侧动脉降支穿支皮瓣12例,桡动脉腕掌支皮瓣5例,骨间后动脉穿支皮瓣14例,桡侧副动脉穿支皮瓣3例,旋髂浅穿支皮瓣、腓动脉穿支皮瓣各1例。皮瓣切取面积为2.0 cm×2.0 cm~12.5 cm×9.0 cm。术后观察皮瓣血运情况、皮瓣存活情况及指关节的屈伸功能。结果36例采用动脉分流调节前负荷穿支皮瓣全部存活,均未发生血管危象,伤口均Ⅰ期愈合,术后随访3~12个月,皮瓣外形良好,质地软,无瘢痕增生,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:优31例,良5例,优良率为100%。结论游离穿支皮瓣通过动脉分流调节前负荷可以自动调节皮瓣供血、减少血管危象的发生,提高游离皮瓣移植的成活率,值得临床推广应用。Objective To investigate the clinical efficacy of free perforator flap in repairing hand soft tissue defect by adjusting preload through arterial shunt.Methods From January 2016 to April 2020,36 patients with hand skin and soft tissue defects were repaired with free perforator flap.The preload was adjusted by arterial shunt during the operation.The Flow-through shunt was used in 16 cases,anastomotic main artery branch shunt in 12 cases and arterial end-to-side anastomotic shunt in 8 cases.There were 12 cases of descending branch of lateral femoral circumflex artery perforator flap,5 cases of carpometacarpal branch of radial artery flap,14 cases of posterior interosseous artery perforator flap,3 cases of radial collateral artery perforator flap,1 case of superficial iliac circumflex artery perforator flap and 1 case of peroneal artery perforator flap.The flap area was 2.0 cm×2.0 cm to 12.5 cm×9.0 cm.The blood supply of the flap,the survival of the flap and the flexion and extension function of the finger joint were observed after operation.Results All the 36 cases of perforator flaps with preload adjustment by arterial shunt survived without vascular crisis,and the wounds achieved primary healing.After follow-up for 3 to 12 months,the flap had good appearance,soft texture,no scar hyperplasia.According to the trial standard of upper limb function evaluation issued by Hand Surgery Society of Chinese Medical Association,the hand function was rated as excellent in 31 cases,good in 5 cases,and the excellent and good rate was 100%.Conclusion The free perforator flap can automatically adjust the blood supply of the flap,reduce the occurrence of vascular crisis and improve the survival rate of free flap transplantation by adjusting the preload through arterial shunt.It is worthy of clinical promotion.

关 键 词：手损伤 外科皮瓣 前负荷 分流 修复 

分 类 号：R658.2[医药卫生—外科学]