高频彩色多普勒超声辅助桡动脉穿支蒂前臂外侧皮神经营养血管皮瓣修复肘部以远软组织缺损  

High-frequency color Doppler ultrasound assisted harvest of radial artery perforator-pedicled lateral forearm neurocutaneous vascular flap to repair soft tissue defect below the elbow

作　　者：王海峰 张一晗 孙鑫洋 王辉[1] 戴江平 Wang Haifeng;Zhang Yihan;Sun Xinyang;Wang Hui;Dai Jiangping(Department of Hand Surgery,the Second Hospital of Tangshan,Tanshan 063000,China)

机构地区：[1]唐山市第二医院手外科,唐山063000

出　　处：《中华整形外科杂志》2024年第9期963-969,共7页Chinese Journal of Plastic Surgery

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

摘　　要：目的探讨高频彩色多普勒超声(HFCDU)辅助桡动脉穿支蒂前臂外侧皮神经营养血管皮瓣修复肘部以远软组织缺损的临床效果。方法回顾性分析2016年1月至2021年6月于唐山市第二医院, 采用桡动脉穿支蒂前臂外侧皮神经营养血管皮瓣修复肘部以远软组织缺损患者的临床资料。术前应用HFCDU对创面周围前臂外侧皮神经及桡动脉穿支走行进行定位、测量, 设计皮瓣旋转点、轴线及切取范围;术中将切取的皮瓣经皮下隧道或明道转移修复创面, 将缺损部位神经残端与皮瓣携带的前臂外侧皮神经行端端吻合;供区创面减张后直接拉拢缝合或取大腿中厚皮片移植修复。术后观察皮瓣成活情况, 以及供区伤口愈合或皮片成活情况。末次随访时, 测量皮瓣静态两点辨距觉;参照Michigan手部功能问卷调查患者对皮瓣外观的满意度, 分为非常不满意(1分)、不满意(2分)、可(3分)、满意(4分)和非常满意(5分);根据温哥华瘢痕量表(VSS)评估供区瘢痕情况, 总分为0~15分, 得分越高表示瘢痕越严重。采用SPSS 27.0软件对数据进行描述性分析。结果共纳入33例患者, 其中男20例, 女13例;年龄(41.0±11.7)岁(23~65岁);缺损部位:前臂6例, 腕部9例, 手部18例;患者均存在骨骼和(或)肌腱外露, 缺损面积为3.0 cm×2.5 cm~12.0 cm×5.0 cm。HFCDU对皮神经和穿支血管的探测结果与术中实际情况一致, 无偏差。33例患者切取皮瓣面积为3.5 cm×3.0 cm~13.0 cm×6.0 cm, 术后皮瓣全部成活, 血运良好, 未发生感染;供区伤口均一期愈合, 所植皮片全部成活。术后随访(15.6±2.9)个月(10~24个月), 患者皮瓣静态两点辨距觉为(12.5±3.3) mm(8~20 mm);Michigan手部功能问卷调查结果显示, 23例患者对皮瓣外观非常满意(5分), 10例为满意(4分);供区瘢痕较轻, VSS评分为(4.3±0.9)分(3~6分)。结论 HFCDU可以对前臂外侧皮神经及桡动脉穿支血管进行精准定位, 据此设�Objective To explore the clinical effectiveness of high-frequency color Doppler ultrasound(HFCDU)assisted harvest of radial artery perforator-pedicled lateral forearm neurocutaneous vascular flap to repair soft tissue defect below the elbow.Methods A retrospective study was conducted on the clinical data of patients who underwent repair of soft tissue defects below the elbow using the radial artery perforator-pedicled lateral forearm neurocutaneous vascular flap at the Second Hospital of Tangshan from January 2016 to June 2021.Prior to the surgery,HFCDU was utilized to identify and measure the course of the lateral forearm cutaneous nerve and the perforating branch of the radial artery surrounding the wound.Subsequently,the flap rotation point,axis,and area were meticulously designed.During the surgical procedure,the skin flap was harvested either through a subcutaneous tunnel or by direct transfer,while the nerve stump at the defect site was anastomosed end-to-end with the lateral cutaneous nerve of the forearm contained in the skin flap.After reducing the wound at the donor site,it was either directly sutured or repaired using a medium-thick skin graft harvested from the thigh.After surgery,the survival of the skin flap,wound healing at the donor site,and the survival of the skin graft were observed.At the last follow-up,the static two-point discrimination of the flap was measured,and patient satisfaction with the appearance of the flap was assessed using the Michigan hand outcomes questionnaire(MHQ).This questionnaire categorized satisfaction into five levels:very dissatisfied(1 point),dissatisfied(2 points),fair(3 points),satisfied(4 points),and very satisfied(5 points).The scar condition of the donor site was evaluated according to the Vancouver scar scale(VSS),which scored from 0 to 15 points,with higher scores indicating more severe scarring.Descriptive analysis of the data was performed using SPSS 27.0 software.Results A total of 33 patients were included in the study,comprising 20 males and 13 females,wi

关 键 词：外科皮瓣 皮神经营养血管皮瓣 桡动脉穿支皮瓣 高频彩色多普勒超声 上肢 软组织缺损 

分 类 号：R658.2[医药卫生—外科学]