游离鱼际穿支皮瓣修复手指指腹缺损  

Repair of finger pulp defect with free thenar perforator flap

作　　者：郑有卯 宋达疆[3] 杨洋[4] 王艺霖 王成 黄文华[1,4] ZHENG Youmao;SONG Dajiang;YANG Yang;WANG Yilin;WANG Cheng;HUANG Wenhua(Guangdong Medical Innovation Platform for Translation of 3D Printing Application,The Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China;Department of Oncology Plastic Surgery,Hunan Cancer Hospital,Changsha 410008,China;Department of Hand and Foot Surgery,Taizhou Hospital of Zhejiang Province,Taizhou,Zhejiang Province 317000,China;Guangdong Engineering Research Centre for Translation of Medical 3D Printing Application,Guangdong Provincial Key Laboratory of Medical Biomechanics,National Key Discipline of Human Anatomy,School of Basic Medical Sciences,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学第三附属医院,广东省医学3D打印应用转化创新平台,广州510630 [2]浙江省台州医院手足外科,浙江台州317000 [3]湖南省肿瘤医院肿瘤整形外科,长沙410008 [4]南方医科大学基础医学院人体解剖学教研室,广东省医学生物力学重点实验室,广东省医学3D打印应用转化工程技术研究中心,广州510515

出　　处：《中华显微外科杂志》2023年第2期163-167,共5页Chinese Journal of Microsurgery

基　　金：深圳市医疗卫生"三名工程"高层次医学团队课题(SZSM20162019);浙江省自然科学基金公益项目(LGFl8H060013)。

摘　　要：目的探讨游离鱼际穿支皮瓣在手指外伤性指腹缺损修复术中的应用效果。方法 2019年9月-2021年11月,浙江省台州医院手足外科对79例手指外伤导致指腹缺损患者行游离鱼际穿支皮瓣移植修复手术。本组男51例,女28例,年龄17~52(37.5±5.2)岁,其中示指指腹缺损34例、中指15例、环指26例、小指4例。所有病例均采用游离鱼际穿支皮瓣进行修复,皮瓣面积为2.0 cm×2.5 cm~3.0 cm×3.5cm。所有鱼际穿支皮瓣以鱼际区域的穿支动脉和皮下浅静脉为蒂,分别与指掌侧固有动脉和指背静脉吻合,同时携带皮下神经与指掌侧固有神经缝接以重建皮瓣感觉。术中发现,27例鱼际优势穿支来源于桡动脉掌浅支,21例来源于掌浅弓,11例来源于拇指指掌侧固有动脉掌指关节穿支,10例来源于桡动脉,10例来源于拇主要动脉。本组皮瓣携带的神经来源于桡神经浅支24例、前臂外侧皮神经终末支22例、正中神经掌侧支33例。手术时间为(96.7±10.7) min。皮瓣供区全部直接闭合,无需植皮。随访方法大部分为门诊,外地及不方便来院的患者采用电话或微信方式进行。结果本组穿支皮瓣均完全成活,皮瓣供区均顺利愈合。随访时间为(20.5±3.8)个月,修复手指指腹外形不臃肿,质地满意,皮瓣TPD为(5.6±0.9) mm,皮瓣供区仅遗留线形瘢痕,鱼际功能无明显影响。结论鱼际穿支皮瓣血管解剖恒定,可以重建皮瓣感觉,皮瓣质地及厚度与手指相似,是一种适合用于修复手指指腹缺损的较理想方法。ObjectiveTo investigate the effect of free thenar perforator flap on repair of finger pulp defect.MethodsFrom September 2019 to November 2021,79 cases of finger injuries complicated with defects in the pulp of fingers received free thenar perforator flap transfer surgery for reconstruction of finger pulps in the Department of Hand and Foot Surgery,Taizhou Hospital,Zhejiang Province.The patients were 51 males and 28 females,aged from 17 to 52(37.5±5.2)years old.There were 34 finger-pulp defects of index fingers,15 of middle fingers,26 of ring fingers and 4 of little fingers.All patients were treated with free thenar perforator flaps sized 2.0 cm×2.5 cm-3.0 cm×3.5 cm.All thenar perforator flaps were pedicled with the perforator artery and subcutaneous superficial vein in the thenar region,and the vessels were anastomosed with the proper palmar digital artery and dorsal digital vein,respectively.At the same time,subcutaneous nerve and proper palmar digital nerve were sutured to reconstruct the sensation of flaps.During the operation,the dominant perforating branch of thenar was found being originated from the superficial palmar branch of radial artery in 27 cases,from the superficial palmar arch in 21 cases,from the perforating branch of metacarpophalangeal proper artery of thumb in 11 cases,from the radial artery in 10 cases and from the main artery of thumb in 10 cases.The origins of nerves within the flaps were found from the superficial branch of radial nerve(24 cases),the terminal branch of lateral cutaneous nerve of forearm(22 cases)and the palmar branch of median nerve(33 cases).The operation time was(96.7±10.7)minutes.The donor site for the flap was closed directly without skin grafting.Most of the follow-up were conducted through the visit of outpatient clinic and the patients from other regions were reviewed via telephone or WeChat.ResultsAll perforator flaps survived completely and the flap donor sites healed smoothly.Follow-up lasted for(20.5±3.8)months.The reconstructed finger pulp was not bulky an

关 键 词：鱼际 穿支皮瓣 指腹缺损 感觉重建 显微外科技术 

分 类 号：R658.2[医药卫生—外科学]