足背外侧静脉网移植修复手掌浅弓缺损八例  

Application of anterior lateral malleolar venous network graft in repair of defect of superficial palmar arch: Report of 8 cases

作　　者：于胜军[1] 马振杰[1] 李晓[1] 付胜强 王志龙[1] 徐俊涛 李英 YU Shengjun;MA Zhenjie;LI Xiao;FU Shengqiang;WANG Zhilong;XU Juntao;LI Ying(Department of Hand Surgery,Yantaishan Hospital,Yantai,Shandong Province 264001,China)

机构地区：[1]山东省烟台市烟台山医院手外科,山东烟台264001

出　　处：《中华显微外科杂志》2022年第6期629-633,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨采用足背外侧静脉网移植修复手掌浅弓缺损的手术方法和临床疗效。方法2015年2月至2021年7月,对烟台山医院手外科收治的8例外伤性手掌浅弓缺损患者采用足背外侧静脉网移植修复,其中男6例,女2例;年龄32~44岁,平均39岁;伴有不同程度肌腱、神经、掌深弓损伤以及指掌侧总动脉或指掌侧固有动脉的损伤,血管缺损长度6.0~10.0 cm,手指血运障碍第1~5指1例,第2~4指5例,第2~5指2例。移植足背外侧血管网移植修复远端3个吻合口5例、4个吻合口1例、5个吻合口2例。手部创面直接缝合关闭2例,2例手部创面急诊行ALTPF移植覆盖,3例手部创面择期行ALTPF移植覆盖,1例择期行尺动脉腕上支皮瓣转移覆盖。术后通过门诊、电话、微信、上门等方式跟踪随访,随访内容包括手指远端血运、皮肤感觉、TPD、手关节屈伸活动度等。结果本组8例手指及移植皮瓣全部一期成活。术后随访10~53个月,平均17.9个月。5例患手伸指、屈指、对指及对掌功能恢复良好,恢复原工作;3例患手屈指和对掌功能受限,能参加轻体力工作。所有患手手指恢复本体感觉,TPD为5~7 mm。按中华医学会手外科学会上肢功能评定试用标准进行手功能评定:优5例,良3例。血管供区为线形瘢痕,功能、外形无影响。结论足背外侧静脉网移植是修复掌浅弓缺损的一种理想手术方式。Objective The surgical method and clinical efficacy was studied on the anterior lateral malleolar venous network grafting in repair of the defects of superficial palmar arch.Methods From February 2015 to July 2021,8 cases(6 males and 2 females;aged 32-44 years old,mean age at 39 years old)were treated in the Department of Hand Surgery of Yantaishan Hospital.Anterior lateral malleolar venous network was grafted to repair the defects of superficial palmar arch of the patients.The patients had different degrees of tendon damage,and injuries of nerve,deep palmar arch,common palmar digital artery or proper palmar digital artery.The length of the vessel defect was 6.0-10.0 cm.Blood supply insufficiency occurred in 1st-5th digits in 1 case,2nd-4th fingers in 5 cases,and 2nd-5th fingers in 2 cases.The anterior lateral malleolar venous network was transferred to repair 3 broken ends of vessels in 5 cases,4 broken ends in 1 case and 5 broken ends in 2 cases.The wound of hand was sutured directly in 2 cases.The emergency surgical repair of the wound of hand by transfer of ALTPF was performed in 2 patients,and elective ALTPF transfer in 3 cases.Forearm dorsi-ulnar flap transfer was performed in 1 case.The follow-up reviews were carried out via the outpatient clinic visit,telephone,WeChat interviews or home visits.The blood supply of the distal digit,skin sensation,TPD,the range of motion of the phalangeal joints were observed.Results The results showed that all the digits and the grafted flaps survived.The follow-up was carried out for 10-53 months,with an average of 17.9 months.The functions of digit extension and flexion,finger opposition and thumb opposition were restored in 5 cases,and the patients returned back to former jobs.The finger flexion and thumb opposition were limited in 3 cases,and these cases participated in light physical work.The proprioception of the digits were recovered,and the TPD was 5-7 mm.Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand

关 键 词：足背静脉弓 静脉网 掌浅弓 移植 

分 类 号：R658.2[医药卫生—外科学]