穿支蒂螺旋桨皮瓣在手部创面修复中的临床应用  

Clinical application of perforator-based propeller flaps in repair of hand wound

作　　者：王辉[1] 王海峰 秦浩宇 郝睿峥[1] 马铁鹏[1] 刘英[2] 王斌[1] WANG Hui;WANG Haifeng;QIN Haoyu;HAO Ruizheng;MA Tiepeng;LIU Ying;WANG Bin(Department of Hand Surgery,Second Hospital of Tangshan,Tangshan Hebei,063000,P.R.China;Department of Functional Examination,Second Hospital of Tangshan,Tangshan Hebei,063000,P.R.China)

机构地区：[1]唐山市第二医院手外科,河北唐山063000 [2]唐山市第二医院功检科,河北唐山063000

出　　处：《中国修复重建外科杂志》2024年第8期1016-1021,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河北省医学适用技术跟踪项目(GZ2021030);唐山市科技计划项目(22150219J);河北省医学科学研究计划项目(20240654)。

摘　　要：目的探讨应用指动脉及掌背动脉穿支蒂螺旋桨皮瓣修复手部创面的临床疗效。方法回顾分析2018年1月—2023年3月收治的45例手部创面患者临床资料。男27例,女18例;年龄14~72岁,平均41.2岁。致伤原因:绞伤15例,压砸伤19例,切割伤11例。受伤部位:手指32例,手背10例,手掌3例;均存在肌腱、关节及骨外露。受伤至手术时间2~8 h,平均4.3 h。清创后创面范围为1.8 cm×1.0 cm~5.0 cm×3.5 cm。采用指动脉穿支蒂螺旋桨皮瓣修复28例,掌背动脉穿支蒂螺旋桨皮瓣修复17例;皮瓣切取范围为2.5 cm×1.1 cm~8.5 cm×4.0 cm。14例供区直接缝合,31例取前臂近端内侧全厚游离皮片植皮修复。结果术后45例皮瓣全部成活,其中2例指动脉穿支蒂螺旋桨皮瓣及1例掌背动脉穿支蒂螺旋桨皮瓣远端肿胀并出现水疱,经换药处理后愈合。供区切口Ⅰ期愈合,植皮均成活。患者均获随访,随访时间10~33个月,平均15.4个月。末次随访时,指动脉穿支蒂螺旋桨皮瓣静态两点辨别觉为4~14 mm,平均8.1 mm;掌背动脉穿支蒂螺旋桨皮瓣为8~20 mm,平均13.3 mm。按照Michigan手部功能问卷评定标准,指动脉穿支蒂螺旋桨皮瓣患者对皮瓣外观非常满意20例,满意8例;掌背动脉穿支蒂螺旋桨皮瓣患者对皮瓣外观非常满意8例,满意9例。参照温哥华瘢痕量表(VSS),指动脉穿支蒂螺旋桨皮瓣患者供区外观评分为2~7分,平均4.2分;掌背动脉穿支蒂螺旋桨皮瓣为4~9分,平均6.1分。结论两种穿支蒂螺旋桨皮瓣血供可靠,切取简便,为急诊修复手部中、小面积创面提供了较好的治疗方法。Objective To investigate the effectiveness of the perforator-based propeller flaps(PPFs)based on digital artery(DA)and dorsal metacarpal artery(DMA)in repairing hand wounds.Methods The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed.There were 27 males and 18 females with an average age of 41.2 years(range,14-72 years).The causes of injury included twist injury in 15 cases,crush injury in 19 cases,and cut injury in 11 cases.The injured parts included 32 cases of digits,10 cases of dorsal hand,and 3 cases of palmar hand,all of which had tendon,joint,and bone exposure.The time from injury to operation ranged from 2 to 8 hours(mean,4.3 hours).The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm.Twentyeight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA.The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm.The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm.Results All the flaps survived after operation.Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change.The incisions in the donor site healed by first intention and the skin grafts survived.All patients were followed up 10-33 months,with a mean of 15.4 months.At last follow-up,the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm,respectively.According to the Michigan Hand Outcomes Questionnaire,20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied;8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied.Based on the Vancouver Scar Scale(VSS),the appearance scores of the donor site of the PPFs based on DA and DMA were 2-

关 键 词：穿支皮瓣 螺旋桨皮瓣 指动脉皮瓣 掌背动脉皮瓣 手部创面 创面修复 

分 类 号：R658.2[医药卫生—外科学]