重建感觉的游离足底内侧动脉穿支皮瓣修复指端创面的效果分析  

Analysis of the effect of sensation reconstructed free medial plantar artery perforator flap in repair of digit-tip defects

作　　者：裴广楠 李甲 滕道练 朱辉 李海建 郑大伟 寿奎水 PEI Guangnan;LI Jia;TENG Daolian;ZHU Hui;LI Haijian;ZHENG Dawei;SHOU Kuishui(Department of Hand Surgery,Xuzhou Renci Hospital,Xuzhou,Jiangsu Province 221004,China)

机构地区：[1]徐州仁慈医院手外科,江苏徐州221004

出　　处：《中华显微外科杂志》2022年第5期534-538,共5页Chinese Journal of Microsurgery

摘　　要：目的回顾性分析应用重建感觉的游离足底内侧动脉穿支皮瓣修复指端创面的临床效果。方法2017年3月至2021年2月,徐州仁慈医院手外科应用足底内侧动脉穿支皮瓣修复指端创面11例,切取皮瓣时分离其感觉神经,与受区指掌侧神经缝接重建皮瓣感觉。创面均有指骨外露,面积为1.2 cm×1.0 cm~2.5 cm×2.2cm,皮瓣切取面积1.6 cm×1.5 cm~3.0 cm×2.7cm。足部供区创面直接缝合10例,植皮修复1例。本组病例均通过门诊复查及微信随访,收集相关资料,包括皮瓣质地、皮纹、出汗、稳定性、感觉、臃肿程度、血液循环状态、使用情况以及供区瘢痕。结果本组11例皮瓣全部成活,其中1例术后12 h出现静脉危象,予以松解敷料、拆除部分缝线后静脉危象解除,后皮瓣顺利成活;供区伤口均愈合良好。术后随访6~18个月,平均10.7个月,皮瓣质地柔软、耐磨,稳定性良好,皮纹恢复,均有少量或正常出汗,有1例皮瓣轻度臃肿,1例皮瓣色泽稍差、温度略低,所有皮瓣感觉恢复良好,均达到S3+级以上,TPD为6.0~8.5 mm,平均7.1 mm,1例患者担心使用患指,3例患者保护性使用患指,足部供区均无磨损及溃疡发生。参考王澍寰对皮瓣功能的评定、中华医学会手外科学会上肢部分功能评定试用标准对本组病例进行评分,优8例,良3例。结论应用游离足底内侧动脉穿支皮瓣修复指端创面,能取得比较好的修复效果,而且供区隐蔽,对行走没有影响,是修复指端创面的理想供区之一。Objective To retrospectively analyse the clinical effect of sensation reconstructed free medial plantar artery perforator flap in repair of digit-tip defects.Methods From March 2017 to February 2021,11 cases with digit-tip defect were repaired by medial plantar artery perforator flap in the Department of Hand Surgery of Xuzhou Renci Hospital.The cutaneous sensory nerves were separated when the flap was harvested,and then the sensory nerves were sutured to the palmar nerves of the digits to reconstruct the sensation of the flap.All wounds had exposure of phalangeal bones,the size of the digit-tip defects was 1.2 cm×1.0 cm-2.5 cm×2.2 cm,the size of the flaps was 1.6 cm×1.5 cm-3.0 cm×2.7 cm.Ten donor sites were directly sutured and 1 was repaired by skin grafting.All patients were included in the postoperative follow-up through outpatient clinic and WeChat reviews to collect relevant information,including texture,sweating,stability,sensation,degree of bloating,blood circulation,usage of the flaps and skin and scars at the donor sites.Results All flaps survived besides 1 case had venous occlusion occurred 12 hours after the operation,and the venous occlusion was relieved by releasing the dressing and removing some of sutures,and the flap survived smoothly.The wounds in the donor sites healed well.The postoperative follow-up period lasted for 6-18 months,with an average of 10.7 months.The flaps were soft,wear-resistant,and stable.The skin texture was restored with a small amount or normal sweating.One flap had mild bloated,and another flap showed a slightly poor colour of the flap together with a lower temperature.The sensory recovery of the flaps was good,reaching S3+or above.The TPD had achieved 6.0-8.5 mm,with an average of 7.1 mm.One patient had concerns in using the affected digit and 3 cases were in protective use of the affected digits.There was no wear and ulcer in the foot donor sites.According to Wang Shuhuan's assessment of flap function and Evaluation Trial Standards of Upper Limb Partial Functional of

关 键 词：足底内侧动脉穿支皮瓣 指端创面 修复 感觉重建 显微外科技术 

分 类 号：R658.2[医药卫生—外科学]