尺动脉源穿支皮瓣组合移植在手指创面修复中的临床应用  

Application effect of combined transplantation of the superior carpal and proximal perforator of ulnar artery flaps in the repair of finger wounds

作　　者：薛成龙 耿士亮 王志红 孔为华 江柯萱 于子云 刘雪涛[1] XUE Chenglong;GENG Shiliang;WANG Zhihong(Department of Orthopedics,The PLA Army 80th Group Army Hospital,Weifang,Shandong,261000,China)

机构地区：[1]中国人民解放军陆军第80集团军医院骨科,山东潍坊261000

出　　处：《实用手外科杂志》2023年第2期155-158,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨尺动脉源腕上穿支及近端穿支皮瓣组合移植在手指两个或单个不规则创面修复中的临床应用效果。方法2018年11月-2020年4月对收治的13例伴软组织缺损手外伤患者,经清创固定血管修复后应用尺动脉源穿支皮瓣组合移植修复。皮瓣切取面积:尺动脉腕上穿支皮瓣为2.0 cm×1.5 cm~3.5 cm×2.0 cm,尺动脉近端穿支皮瓣为2.5 cm×2.0 cm~5.0 cm×3.5 cm。供区均一期直接缝合。术后通过门诊、电话及微信等方式定期随访,观察皮瓣成活、外观、功能恢复及供区愈合情况。结果13例皮瓣中12例成活,1例皮瓣坏死后基底肉芽组织生长丰富行植皮手术;2例出现动脉危象,经手术探查后危象解除顺利成活。所有病例术后均无感染发生;4例因皮瓣臃肿行皮瓣修整手术,均取得满意效果。术后随访12~24(平均15)个月,皮瓣外形满意,皮肤颜色及质地与周围皮肤差异较小,弹性好,皮瓣无溃疡形成。皮瓣供区术后呈线性瘢痕,位置相对隐蔽,功能评定按照中华医学会手外科学会上肢部分功能评定试用标准:优10例,良3例,优良率为100%。结论尺动脉源穿支皮瓣组合移植在手指两个或不规则创面手外伤的修复中效果好,供区不需植皮,瘢痕隐蔽,为手指不规则创面治疗提供一种良好的思路及手术方法。Objective To investigate the clinical effect of combined transplantation of the forearm superior carpal perforator flap and proximal perforator flap derived from the ulnar artery in the repair of two or a single irregular finger wounds.Methods From November 2018 to April 2020,13 cases of hand injuries with soft tissue defects were treated by the combined transplantation of ulnar artery perforator flap,after debridement fixation and vascular repair.Area of flap:forearm superior carpal perforator flap:2.0 cmx1.5 cm~3.5 cm×2.0 cm,proximal perforator flap of ulnar artery:2.5 cm×2.0 cm~5.0 cm×3.5 cm.The donor site of 13 cases can be directly sutured at one stage.The survival,appearance,functional recovery and donor site healing of the flap were observed by regular follow-up through outpatient,telephone and WeChat.Results Twelve of 13 flaps survived.One case had rich basal granulation tissue after necrosis and underwent skin grafting.Among them,2 cases had arterial crisis.After surgical exploration,the crisis was relieved and survived successfully.No infection occurred in all cases after surgery.Among them,4 cases underwent skin flap repair because of the bloated skin flap.Follow up of 12 to 24 months(average 15 months)showed that the appearance of the skin flap was satisfactory,the color and texture of the skin were less different from those of the surrounding skin,the elasticity was good,and the skin flap had no ulcer.The donor site of the flap showed linear scar after operation,and the position was relatively hidden.According to Trial criteria for functional evaluation of upper limb of the Hand Surgery Society of the Chinese Medical Association,10 cases were excellent,3 cases were good,and the excellent and good rate was 100%.Conclusion The combined transplantation of the perforator flap from the ulnar artery has a good clinical effect in the repair of two or irregular wounds of the fingers.The donor site does not need skin grafting,and the scar is hidden.It provides a good idea and surgical method for the treatm

关 键 词：尺动脉源穿支皮瓣 手指创面 组合修复 

分 类 号：R658.2[医药卫生—外科学]