以骨间后动脉穿支为蒂的V-Y接力皮瓣修复手背部创面  

Clinical application of V-Y relay flap pedicled with posterior interosseous artery perforator for repairing dorsal hand wounds

作　　者：陆浩 薛明宇 强力 周晓 Lu Hao;Xue Mingyu;Qiang Li;Zhou Xiao(Department of Hand Surgery,Wuxi No.9 People's Hospital Affiliated to Suzhou University,Wuxi 214062,China)

机构地区：[1]苏州大学附属无锡市第九人民医院手外科,无锡214062

出　　处：《中华手外科杂志》2023年第1期40-43,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨以骨间后动脉穿支为蒂的V-Y接力皮瓣修复手部创面的疗效。方法自2019年1月至2021年10月我科收治手背部创面患者7例,男5例,女2例;年龄31~69岁,平均49.7岁。损伤原因:碾轧伤3例,热压伤1例,机器绞伤3例。创面缺损大小6.5 cm×5.5 cm~10.5 cm×8.0 cm,带骨间后动脉尺侧终支穿支皮瓣大小7.0 cm×6.0 cm~11.0 cm×8.5 cm,转位修复创面,并以大小为5.5 cm×2.5 cm~8.0 cm×4.0 cm的骨间后动脉桡侧终支穿支皮瓣V-Y推进修复供区。结果术后二块皮瓣顺利存活,供、受区创面均I期愈合;未发生血管危象、切口裂开和明显肿胀等情况。7例患者均获得随访,时间6~24个月,平均16个月。皮瓣质地柔软,外观满意,蒂部无臃肿。带骨间后动脉尺侧终支穿支皮瓣两点分辨觉为8~18 mm,平均(11.5±0.5)mm;骨间后动脉桡侧终支穿支皮瓣两点分辨觉为7~15 mm,平均(9.0±0.5)mm;供区仅残留线状瘢痕,颜色及外观轮廓自然。结论骨间后动脉穿支接力皮瓣修复手部创面具有不牺牲主干血管、操作简便,避免供区植皮,减小前臂损伤等优点,是修复手部皮肤软组织缺损的良好办法。Objective To explore the clinical efficacy of V-Y relay flap pedicled with posterior interosseous artery perforator in repairing hand wounds.Methods From January 2019 to October 2021,our department treated 7 patients with dorsal hand wounds,including 5 males and 2 females.The age ranged from 31 to 69 years,with an average of 49.7 years.The causes of injury included rolling injury in 3 cases,hot pressing injury in 1 case and machine wringing injury in 3 cases.The wound defect area ranged from 6.5 cm×5.5 cm to 10.5 cm×8.0 cm.The size of the perforator flap with the ulnar terminal branch of the posterior interosseous artery was 7.0 cm×6.0 cm to 11.0 cm×8.5 cm,transposed to repair the wound.And the donor site was repaired by the V-Y advance of perforator flap of the radial terminal branch of the posterior interosseous artery with the size being 5.5 cm×2.5 cm to8.0 cm×4.0 cm.Results The two flaps survived succssfully and the donor and recipient wounds achieved primary healing.There was no vascular crisis,incision dehiscence and obvious swelling.All the 7 patients were follow-up for 6 to 24 months,with an average of 16 months.The skin flap was soft in texture and satisfactory in appearance,with no swelling in the pedicle.The two-point discrimination of the perforator flap with the ulnar terminal branch of the posterior interosseous artery was 8 to 18 mm,with an average of(11.5±0.5)mm.The two-point discrimination of the perforator flap with the radial terminal branch of the posterior interosseous artery was 7 to 15 mm,with an average of(9.0±0.5)mm.Only linear scars remained in the donor site,with natural color and appearance.Conclusion The relay flap of perforating branch of posterior interosseous artery has the advantages of not sacrificing the main blood vessels,simple operation,avoiding skin grafting in donor area and reducing forearm injury,which is a good method for repairing skin and soft tissue defects of hand.

关 键 词：手损伤 外科皮瓣 骨间后动脉穿支 软组织缺损 

分 类 号：R658.2[医药卫生—外科学]