游离同侧骨间背动脉多个穿支皮瓣修复多指皮肤缺损  

Free ipsilateral posterior interosseous artery flap with multiple perforating branches for re-pair of multi-finger skin defects

作　　者：张永超 安宝鑫 韩海元 赵志钢 王剑利 Zhang Yongchao;An Baoxin;Han Haiyuan;Zhao Zhigang;Wang Jianli(Department of Surgery,Weifang Medical University,Weifang,Shandong Province201053,China;PLA Trauma Orthopaedic Research Institute,80h Group Military Hospital of the PLA,Weifang,Shandong Province201021,China)

机构地区：[1]潍坊医学院外科学教研室,山东潍坊201053 [2]陆军第80集团军医院全军创伤骨科研究所,山东潍坊201021

出　　处：《创伤外科杂志》2024年第1期61-66,共6页Journal of Traumatic Surgery

基　　金：潍坊市科技发展计划项目(2020YX080)。

摘　　要：目的探讨多手指皮肤缺损的修复方法。方法回顾性分析2019年9月—2022年6月陆军第80集团军医院全军创伤骨科研究所收治的2~3个手指皮肤缺损伤患者9例,男性6例,女性3例;年龄34~57岁,平均46.2岁;机械性损伤7例,重物挤压伤2例。全部患者Ⅰ期行清创负压封闭引流(VSD),Ⅱ期应用游离同侧骨间背动脉的多个穿支皮瓣分别修复多指创面,皮肤软组织缺损面积1.5 cm×3.0 cm~2.5 cm×6.5 cm,皮瓣切取面积2.0 cm×3.5 cm~3.0 cm×7.0 cm,皮瓣供区直接缝合,皮瓣皮神经与指神经残端或指背神经残端吻合重建感觉功能,观察皮瓣血运、外观、质地及静态两点辨别觉。根据中华医学会手外科学会上肢部分功能评定试用标准评定并按照英国医学研究会评定标准评估感觉恢复程度。结果9例皮瓣均未出现动脉危象,1例中指皮瓣第2天出现静脉危象并形成黑色结痂,退痂后外观无明显异常。患者均获9~12个月随访,平均11.3个月。皮瓣均愈合良好,供区直接缝合或植皮,仅遗留不明显瘢痕。皮瓣两点辨别觉为6.0~11.0 mm,平均8.7 mm。根据中华医学会手外科学会上肢部分功能评定试用标准,优8例,良1例;按照英国医学研究会评定标准,皮瓣感觉均恢复至S3+。结论游离同侧骨间背动脉多个穿支皮瓣具有易切取、血管较恒定、外形美观等优点,可同时修复多指皮肤缺损并恢复部分感觉功能,是治疗多手指皮肤缺损的有效方法。Objective To explore the outcome of multiple finger skin defects repaired by free ipsilateral posterior interosseous artery flaps with multiple perforating branches.Methods This retrospective analysis was conducted on 9 patients with multiple finger skin defects(involving 2-3 fingers)who were admitted to the PLA Trauma Orthopedics Research Institute of the 80th Group Military Hospital of the PLA from Sep.2019 to Sep.2022.There were 6 males and 3 females aged 34-57(mean 46.2)years,with 7 cases of machine trauma and 2 crush injuries by heavy objects.All of the patients underwent stage I debridement+vacuum sealing drainage,and stage II repair by free ipsilateral posterior interosseous artery flaps with multiple perforating branches.The skin and soft tissue defect size was 1.5 cm×3.0 to 2.5 cm×6.5 cm and the flap cutting size of 2.0 cm×3.5 to 3.0 cm×7.0 cm.The donor site was directly sutured.The cutaneous nerve of the flap was anastomosed with the stump of the digital nerve or the dorsal digital nerve to reconstruct the sensory function.The blood supply,appearance,texture and static twopoint discrimination of the transplanted flap were observed.The sensory recovery of the injured hand was evaluated according to the criteria proposed by the Hand Surgery Society of the Chinese Medical Association and the British Medical Research Association.Results No arterial crisis occurred in the 9 cases.One case of middle finger flap developed a venous crisis and formed black scabs on the second day,and the appearance was not significantly different from normals after scab removal.Patients were followed up for 9 to 12 months,mean 11.3 months.The flaps healed well,and the donor site by direct suture or skin grafting showed no obvious scars.The two-point sensation of the flaps was 6.0-11.0 mm,mean 8.7 mm.According to the functional evaluation criteria of the upper limb by the Hand Surgery Society of the Chinese Medical Association,8 cases were excellent and 1 was good.According to the evaluation criteria of the British Medical Re

关 键 词：手指缺损 游离皮瓣 骨间背动脉 显微外科 

分 类 号：R622.1[医药卫生—整形外科]