腕横纹Flow-through皮瓣修复手指软组织合并血管缺损6例  

Application of Flow-through flap of wrist transverse crease in reconstruction of soft tissue defect of fingers complicated with vascular defect:a report of 6 cases

作　　者：田茂元 单贵霖 张龙[2] 王剑利[2] TIAN Maoyuan;SHAN Guilin;ZHANG Long;WANG Jianli(Department of Hand and Foot Surgery,Weifang Ruiqing Hospital,Weifang,Shandong Province 261000,China;Department of Orthopaedic Trauma,the 80th Group Military Hospital of the Chinese People's Liberation Army,Weifang,Shandong Province 261000,China)

机构地区：[1]潍坊瑞清医院手足外科,山东潍坊261000 [2]中国人民解放军陆军第80集团军医院创伤骨科,山东潍坊261000

出　　处：《中华显微外科杂志》2024年第2期178-182,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨腕横纹Flow-through皮瓣在手指软组织合并血管缺损中的临床应用。方法2013年1月-2018年6月,潍坊瑞清医院手足外科对6例手指软组织缺损面积在3.0 cm×1.5 cm~2.5 cm×7.0 cm之间的软组织合并血管缺损患者进行治疗,右手5例,左手1例;示指2指,中指3例,环指1例;4例行一期清创急诊以腕横纹Flow-through皮瓣修复;2例行一期清创,创面稳定后二期采取腕横纹Flow-through皮瓣修复,皮瓣切取范围为创面一致布样并放大10%,皮瓣大小3.8 cm×2.0 cm~8.0 cm×3.0 cm。供区均直接缝合。分别在术后第1、3、6、12、24个月来院门诊复诊,观察皮瓣外形、质地和受区皮肤感觉,手指功能按照中华医学会手外科学会上肢部分功能评定试用标准进行评定。结果4例皮瓣完全成活,2例出现皮瓣远端表皮下张力性水疱,给予抬高患肢、针刺水疱减压处理后皮瓣完全成活。术后6例均获得随访,时间5~60个月,皮瓣质地接近手指皮肤质地,厚薄适中,均未行皮瓣修整。根据中华医学会手外科学会上肢部分功能评定试用标准,皮瓣区感觉恢复S 1~S 3,外观满意,手指运动总活动度(TAM)达健侧75%以上,为130°~180°,日常生活活动(ADL)评分为11~17分,结果均为良。供区切口均一期愈合。结论采用腕横纹Flow-through皮瓣修复手指软组织合并血管缺损,重建手指血运同时修复创面,皮瓣质地优良,可直接缝合,对于腕关节功能无明显影响,值得临床推广应用。Objective To investigate the clinical application of Flow-through flap of wrist transverse crease in reconstruction of soft tissue defecte of fingers complicated with vascular defects.Methods From January 2013 to June 2018,6 patients with finger soft tissue defects(3.0 cm×1.5 cm-2.5 cm×7.0 cm in size)and complicated with blood vessels defects were treated in the Department of Hand and Foot Surgery of Weifang Ruiqing Hospital.There were 5 soft tissue defects in the right hand and 1 in the left hand.The defects were found in 2 index fingers,3 middle fingers,and 1 ring finger.Four patients received primary reconstruction surgery with Flow-through flaps right after emergency debridement.Two patients received primary debridement and followed by phase II reconstruction surgery with Flow-through flaps after the wounds had been stabilised.Range of incision for the flaps was consistent with the wound templates but with a 10%larger in size.The size of flaps was 3.8 cm×2.0 cm-8.0 cm×3.0 cm.All donor sites were sutured directly.The shape,texture and skin sensation of the flaps were evaluated through follow-up at 1,3,6,12 and 24 months after surgery.Functional recovery was evaluated according to the Evaluation Trial Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results Four flaps survived,but 2 flaps had sub-epidermal tension blisters at the distal end of flaps.The 2 flaps survived after decompression measures of keeping the affected limb elevated and having blisters punctured.All the patients were included in the postoperative follow-up for 5-60 months.Texture of the flaps was close the finger skin,the flaps were in suitable thickness without further trimming.Sensation in the flaps recovered to S 1-S 3,and the appearance was satisfactory.According to the Evaluation Trial Standard of Upper Limb Partial Function of the Hand Surgery of Chinese Medical Association,total active motion(TAM)of the affected fingers recovered to over 75%of the healthy side(130°-180°).Activities of dail

关 键 词：腕横纹皮瓣 指 软组织缺损 血管缺损 血流桥接皮瓣 重建 

分 类 号：R658.2[医药卫生—外科学]