改良掌背动脉逆行岛状皮瓣修复手部较大面积皮肤缺损  

Repairing large skin defect of hand with modified dorsal metacarpal artery reverse island flap

作　　者：王辉[1] 霍永鑫[1] 王红涛 贾鑫玮 张一晗 WANG Hui;HUO Yongxin;WANG Hongtao;JIA Xinwei;ZHANG Yihan(Department of Hand Surgery,Second Hospital of Tangshan,Tangshan Hebei,06300,P.R.China)

机构地区：[1]唐山市第二医院手外科,河北唐山063000

出　　处：《中国修复重建外科杂志》2022年第10期1273-1276,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨以相邻2条掌背动脉返支为血供的改良掌背动脉逆行岛状皮瓣修复手部较大面积皮肤缺损的临床疗效。方法2017年9月—2021年3月收治15例手部较大面积皮肤缺损患者。男11例,女4例;年龄24~66岁,平均42岁。致伤原因:机器绞伤6例,砸伤5例,挤压伤4例。受伤部位:手指皮肤缺损6例,手掌、手背远端皮肤缺损9例;均存在肌腱、关节及骨外露。受伤至手术时间2~6 h,平均4 h。彻底清创后皮肤缺损范围为3.5 cm×3.0 cm~8.0 cm×4.5 cm。采用范围为3.8 cm×3.3 cm~9.0 cm×5.0 cm的改良掌背动脉逆行岛状皮瓣进行修复。皮瓣供区采用全厚皮片植皮修复。结果术后皮瓣全部顺利成活,受区创面及供区植皮均Ⅰ期愈合。15例患者均获随访,随访时间9~24个月,平均14个月。皮瓣外观良好,质地、色泽与周围正常组织接近。供区无明显瘢痕挛缩、凹陷及色素沉着。末次随访时皮瓣静态两点辨别觉为8~20 mm,平均13.6 mm。按照Michigan手部功能问卷评定标准,患者对皮瓣外观非常满意5例,满意10例。结论以相邻2条掌背动脉返支为血供的改良掌背动脉逆行岛状皮瓣血供可靠、切取面积大、操作简便、供区损伤小,适合急诊修复手部较大面积皮肤缺损。Objective To investigate the effectiveness of modified dorsal metacarpal artery reverse island flap based on two adjacent recurrent branches of dorsal metacarpal arteries in repairing large skin defect of the hand.Methods Between September 2017 and March 2021,15 cases of large skin defect of the hand were treated.There were11 males and 4 females with an average age of 42 years(range,24-66 years).The injury causes included machine twist injury in 6 cases,pound injury in 5 cases,and crush injury in 4 cases.The injured parts included 6 cases of finger skin defect and 9 cases of distal skin defect of palm and dorsum of hand,all of which had tendon,joint,and bone exposure.The interval from injury to operation ranged from 2 to 6 hours(mean,4 hours).The defect sizes after thorough debridement ranged from 3.5 cm×3.0 cm to 8.0 cm×4.5 cm.The modified dorsal metacarpal artery reverse island flap with a range of3.8 cm×3.3 cm to 9.0 cm×5.0 cm was used to repair the defect,and the flap donor site was repaired with full-thickness skin graft.Results All the flaps survived successfully after operation,and the wounds in the recipient site and the skin grafts in the donor site healed by first intention.All patients were followed up 9-24 months,with an average of 14 months.The appearance of the flap was good,and its texture and color were similar to those of the surrounding normal tissue.There was no obvious scar contracture,depression,and pigmentation in the donor site.At last follow-up,the static two-point discrimination of the flap was 8-20 mm,with an average of 13.6 mm.According to the Michigan Hand Outcome Questionnaire,5 patients were very satisfied with the appearance of the flap,and 10 patients were satisfied.Conclusion The modified dorsal metacarpal artery reverse island flap based on two adjacent recurrent branches of dorsal metacarpal arteries has reliable blood supply,larger harvested area,simple procedure,and minimal donor site damage,which is suitable for emergency repair of large skin defect of the hand.

关 键 词：掌背动脉皮瓣 手部皮肤缺损 创面修复 

分 类 号：R658.2[医药卫生—外科学]