改良股薄肌肌皮瓣游离移植重建前臂屈指功能  

Transfer of modified free gracilis myocutaneous flap in reconstruction of digit flexion function in forearm

作　　者：黄显军 姜磊 鲍晶晶 郭征东 乔林[2] HUANG Xianjun;JIANG Lei;BAO Jingjing;GUO Zhengdong;QIAO Lin(Department of Hand and Foot Surgery,Zhejiang Rongjun Hospital,Jiaxing,Zhejiang Province 314000,China;Department of Orthopaedics, the 987th Hospital of PLA, Baoji, Shanxi Province 721004, China)

机构地区：[1]浙江省荣军医院手足外科,浙江嘉兴314000 [2]中国人民解放军联勤保障部队第九八七医院骨科,陕西宝鸡721004

出　　处：《中华显微外科杂志》2024年第4期410-415,共6页Chinese Journal of Microsurgery

摘　　要：目的观察应用改良股薄肌肌皮瓣游离移植重建前臂屈指功能的手术方法和临床疗效。方法2014年3月至2022年8月,浙江省荣军医院手足外科应用改良股薄肌肌皮瓣游离移植重建前臂屈指功能障碍7例。7例均为男性,年龄23~38岁,平均28岁。切除瘢痕后,前臂创面15.0 cm×4.5 cm~28.0 cm×6.5 cm,皮瓣切取面积17.0 cm×5.5 cm~30.0 cm×8.0 cm,皮瓣携带的神经-股薄肌支(闭孔神经前支)与正中神经肌支缝接,股薄肌穿支动、静脉分别与肱动脉或尺、桡动脉的分支相吻合。6例供区给予直接拉拢缝合,1例供区经拉拢缝合缩小创面后,于同侧腹股沟区切取中厚皮片覆盖遗留创面。术后通过门诊、电话或微信随访其临床疗效。结果术后1例皮瓣发生血管危象,经手术重新吻合血管解除;1例皮瓣远端约2.0 cm×1.0 cm区域坏死,经换药后愈合;其余5例皮瓣顺利成活。术后随访12~36个月,平均18个月。皮瓣外形、质地良好,6个月后恢复不同程度的保护性感觉。术后2年随访,7例患者手及前臂外形均得到明显改善,并恢复屈指、抓捏及对指等部分手功能。参照中华医学会手外科学会上肢部分功能评定试用标准:屈指功能恢复优1例,良3例,可3例。供区除线形瘢痕或轻度色素沉着外,无明显功能丧失。结论改良股薄肌肌皮瓣游离移植重建前臂屈指功能,手术安全、可靠,术后前臂屈指功能较为满意,是修复重建前臂屈指功能的理想术式。ObjectiveTo observe the surgical methods and clinical efficacy on reconstruction of digital flexion function using transfer of modified free gracilis myocutaneous flap.MethodsBetween March 2014 and August 2022,7 male patients,aged between 23 and 38(average age 28)years old,were treated by reconstruction of forearm flexor function using modified free gracilis myocutaneous flap transfer to overcome the dysfunction in the Department of Hand and Foot Surgery,Zhejiang Rongjun Hospital.After the scar excision,the defects in forearm ranged from 15.0 cm×4.5 cm to 28.0 cm×6.5 cm,with flap excision areas of 17.0 cm×5.5 cm to 30.0 cm×8.0 cm.The nerve carried by the myocutaneous flap was anastomosed with the musculi branch of the median nerve,and the perforator artery and vein of the gracilis muscle were anastomosed with the brachial artery or the branch of ulnar artery and radial artery.Six patients had the flap donor sites directly closed primarily.A medium-thickness skin graft was taken from the ipsilateral groin area in 1 patient,to cover the remaining wound after the primary closure for wound reduction.Postoperative clinical efficacy was monitored through the follow-ups via visits of outpatient clinic,telephone calls or WeChat interviews.ResultsAfter surgery,1 patient experienced a vascular compromise of the flap,which was resolved after reanastomosis.One patient had a necrotic in distal flap about 2.0 cm×1.0 cm in size,which healed after dressing change.All other 5 flaps survived successfully.The postoperative follow-up ranged from 12 to 36 months,at 18 months in average.The flaps had good appearance and texture.Protective sensation recovered to varying degrees at 6 months after surgery.At 2 years after surgery,all of 7 patients showed significant improvement in hand and forearm appearance,along with restored finger flexion,grasping and partial hand function.According to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association,flexion function recovered to excellent in 1 pati

关 键 词：股薄肌肌皮瓣 移植 前臂 功能重建 显微外科技术 

分 类 号：R658.2[医药卫生—外科学]