第2掌背动脉穿支皮瓣接力示指背侧岛状皮瓣修复拇指创面的疗效  

Effects of the second dorsal metacarpal artery perforator flap relaying the dorsal island flap of index finger in repairing thumb wounds

作　　者：陈艳[1] 谢斌 刘远俊 吴健[1] Chen Yan;Xie Bin;Liu Yuanjun;Wu Jian(Department of Burns,Gansu Provincial People's Hospital,Lanzhou 730000,China;The First Clinical Medical College,Gansu University of Traditional Chinese Medicine,Lanzhou 730099,China)

机构地区：[1]甘肃省人民医院烧伤科,兰州730000 [2]甘肃中医药大学第一临床医学院,兰州730099

出　　处：《中华烧伤与创面修复杂志》2024年第10期971-977,共7页Chinese Journal of Burns And Wounds

基　　金：甘肃省科技计划项目(23YFFA0050);兰州市科技计划项目(2023-ZD-29);甘肃省人民医院院内科研基金项目(23GSSYB-13)。

摘　　要：目的探讨采用第2掌背动脉穿支皮瓣接力示指背侧岛状皮瓣修复拇指创面的疗效。方法该研究为回顾性观察性研究。2021年5月—2023年1月,甘肃省人民医院收治14例符合入选标准的拇指创面患者,其中男8例、女6例,年龄24~63岁。清创后创面面积为2.1 cm×1.2 cm~5.5 cm×3.5 cm。用示指背侧岛状皮瓣(切取面积为2.4 cm×1.5 cm~5.5 cm×3.5 cm)修复拇指创面,然后经同一切口切取第2掌背动脉穿支皮瓣(切取面积为2.7 cm×1.6 cm~5.7 cm×3.6 cm)修复示指供区创面,将手背供区创面直接缝合。术后观察皮瓣成活情况及手背供区创面愈合情况。随访患者手背供区创面情况,皮瓣颜色、外观、质地,术后并发症情况,恢复工作及对治疗效果满意度情况。末次随访时,参照中华医学会手外科学会上肢部分功能评定试用标准评定拇指及示指功能。结果术后皮瓣均成活,手背供区创面均愈合。术后随访6~12个月,患者手背供区创面仅遗留线性瘢痕,皮瓣颜色与周围正常皮肤相似、外观饱满、质地柔软,无瘢痕触痛或瘢痕挛缩等并发症。患者拇指及示指感觉正常,均恢复正常工作,且对治疗效果表示满意。末次随访时,拇指及示指功能评定为优者9例、良者5例。结论采用第2掌背动脉穿支皮瓣接力示指背侧岛状皮瓣修复拇指创面,不损伤主要血管,术后手背供区创面仅遗留线性瘢痕,皮瓣外观及示指、拇指功能较好,手术操作相对简单,具有较佳的临床效果。Objective To explore the effects of the second dorsal metacarpal artery perforator flap relaying the dorsal island flap of index finger in repairing thumb wounds.MethodsThe study was a retrospective observational study.From May 2021 to January 2023,14 patients with thumb wounds who met the inclusion criteria were admitted to Gansu Provincial People's Hospital,including 8 males and 6 females,aged 24 to 63 years.After debridement,the wound area was 2.1 cm×1.2 cm to 5.5 cm×3.5 cm.The dorsal island flap of index finger with incision area of 2.4 cm×1.5 cm to 5.5 cm×3.5 cm was used to repair the thumb wound,and then the second dorsal metacarpal artery perforator flap with incision area of 2.7 cm×1.6 cm to 5.7 cm×3.6 cm was cut through the same incision to repair the donor wound in the index finger,and the donor wound in the dorsal of hand was directly sutured.The survival of flap was observed,and the healing of the donor wound in the dorsal of hand was observed after operation.The condition of donor wound in the dorsal of hand,the color,appearance,and texture of flap,postoperative complications,return to work,and satisfaction with the treatment effect of patients were followed up.At the last follow-up,the function of the thumb and the index finger was evaluated with the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association.ResultsAfter operation,all flaps survived,and the donor wounds on the back of the hands healed.During follow-up of 6-12 months,only linear scars remained on the donor wounds in the dorsal of hands,and the color of flaps was similar to that of the surrounding normal skin,with a full appearance and soft texture.There were no complications such as scar tenderness or scar contracture in any patient.All patients had normal sensation in the thumb and index finger,resumed normal work,and were satisfied with the treatment effects.At the last follow-up,the function of thumb and index finger was evaluated as excellent in 9 cases a

关 键 词：穿支皮瓣 外科皮瓣 拇指 指损伤 显微外科手术 创面修复 第2掌背动脉 

分 类 号：R658.2[医药卫生—外科学]