桡侧副动脉穿支皮瓣在中重度虎口挛缩修复中的应用  

Application of radial collateral artery perforator flap on reconstruction of moderate-severe thumb web contracture

作　　者：俞芳[1] 唐举玉[1] 吴攀峰[1] 曾磊[1] 卿黎明[1] 肖勇兵[1] 潘丁[1] Yu Fang;Tang Juyu;Wu Panfeng;Zeng Lei;Qing Liming;Xiao Yongbing;Pan Ding(Department of Orthopedics-Hand and Microsurgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨科-手显微外科,长沙410008

出　　处：《中华整形外科杂志》2024年第9期929-935,共7页Chinese Journal of Plastic Surgery

基　　金：湖南省自然科学基金(2023JJ30967)。

摘　　要：目的探讨桡侧副动脉穿支皮瓣移植修复中重度虎口挛缩松解后创面的临床疗效。方法回顾性分析2018年9月至2022年9月于中南大学湘雅医院骨科-手显微外科采用桡侧副动脉穿支皮瓣修复中重度虎口挛缩松解后创面患者资料。术前以桡侧副动脉穿支穿出点为中心, 三角肌止点和肱骨外髁顶点连线为轴线设计皮瓣。术中首先切除虎口区皮肤瘢痕, 松解深筋膜、肌肉等挛缩组织, 之后沿设计线切取皮瓣转移至受区创面, 显微镜下行血管、神经吻合后, 切口间断缝合, 放置引流管;供区直接缝合。术后观察皮瓣存活及并发症情况。末次随访时测量虎口间距及角度, 评价虎口形态、功能恢复情况(分为优、良、中、差)和感觉恢复效果(从S0级至S4级代表感觉无恢复至完全恢复)。结果共纳入8例患者, 男7例, 女1例;年龄23~56岁, 平均40.3岁;术前虎口间距为20~38 mm, 平均26.9 mm;虎口角度22°~36°, 平均27.4°;重度挛缩5例, 中度挛缩3例。术中切取皮瓣面积为5.5 cm×3.5 cm~13.0 cm×6.5 cm。术后7例皮瓣顺利成活, 1例出现静脉危象, 行血管探查后完全存活, 供区和受区切口均一期愈合。随访6个月至2.5年, 平均13.6个月, 末次随访时虎口间距为48~63 mm, 平均57.1 mm;虎口角度为40°~52°, 平均44.8°;虎口修复评价显示, 优5例, 良3例;患者对虎口外观满意, 感觉恢复至S3级3例, S2级4例, S1级1例。供区愈合良好, 有瘢痕遗留, 无桡神经损伤, 肘关节活动正常。结论桡侧副动脉穿支皮瓣血供可靠, 切取相对简单, 术后虎口外观和功能恢复良好, 是修复中重度虎口挛缩松解后皮肤缺损的较好方法。Objective To explore the efficiency of radial collateral artery perforator flap to reconstruct defects of thumb web contracture release.Methods The data of patients with moderate to severe thumb web contracture treated with radial collateral artery perforator flap from September 2018 to September 2022 in Department of Orthopedics-Hand Microsurgery of Xiangya Hospital,Central South University were analyzed retrospectively.A skin flap with the radial collateral artery perforating point as the center and the line connecting the deltoid muscle insertion point and the apex of the humeral lateral condyle as the axis were designed before surgery.During the operation,the skin scar in the thumb web area was first removed,and the contracted tissues such as deep fascia and muscles were loosened.Then,a skin flap was harvested along the design line and transferred to the recipient site.After vascular and nerve anastomosis under a microscope,the incision was intermittently sutured and a drainage tube was placed.The blood flow of the flap and complication were monitored closely.In the last follow-up,the distance and angle of thumb web were observed;the appearance,sensory recovery(excellent,good,moderate,and poor)and the hand function(S0 level to S4 level represented feeling no recovery to complete recovery)were evaluated.Results A total of 8 patients were included,including 7 males and 1 female,aged 23-56 years(average of 40.3 years old).The distance of thumb web was 20-38 mm(average 26.9 mm),and the angle was 22°-36°(average 27.4°)before surgery.Five hands were classified as severe thumb web contracture,and 3 hands were moderate.The sizes of perforator flap were from 5.5 cm×3.5 cm-13.0 cm×6.5 cm.Seven flaps survived uneventfully and venous congestion occurred in 1 flap.After exploration,the flap survived completely.Primary healing of wounds occurred in the donor and recipient areas.Postoperative follow-up ranged from 6 months to 2.5 years(average 13.6 months).In the last follow-up,the distance of thumb web was 48-63 mm(av

关 键 词：外科皮瓣 穿支皮瓣 桡侧副动脉 虎口挛缩 修复 

分 类 号：R658.2[医药卫生—外科学]