中国修复重建外科杂志

中国修复重建外科杂志

改良动脉化静脉皮瓣修复手指软组织缺损

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目的探讨一种改良动脉化静脉皮瓣修复手指软组织缺损的疗效。方法2017 年 1 月—2018 年 4 月,收治 16 例手指软组织缺损患者。男 12 例,女 4 例;年龄 24~74 岁,平均 41 岁。软组织缺损原因:瘢痕挛缩切除后 1 例,机器绞压伤 15 例。拇指 3 例,示指 5 例,中指 4 例,环指 2 例,小指 2 例;手指掌侧缺损 4 例,背侧缺损 12 例。软组织缺损范围为 3 cm×2 cm~10 cm×3 cm。于前臂掌侧设计并切取改良动脉化静脉皮瓣,皮瓣完全游离前在显微镜下剔除部分脂肪组织,并结扎皮瓣内 2 根静脉间的所有细小分支,游离移植修复创面。皮瓣切取范围为 2.5 cm×2.0 cm~10.0 cm×3.0 cm。供区游离植皮修复(1 例)或直接缝合(15 例)。结果术后 1 例皮瓣发生静脉危象;15 例皮瓣均顺利成活,其中 3 例皮瓣术后出现轻度至中度肿胀,未作特殊处理,1 周后自行愈合。供区植皮成活,切口 Ⅰ 期愈合。术后 13 例获随访,随访时间 8~16 个月,平均 11 个月。患者皮瓣质地软、耐磨,外形满意。末次随访时,皮瓣感觉单丝触压觉测试为 2.83~4.56 g,平均 4.01 g;静态两点辨别觉为 6~20 mm,平均 12 mm。结论改良动脉化静脉皮瓣通过改善动脉化静脉皮瓣内的动静脉分流,减轻术后静脉回流不畅,修复手指软组织缺损可获得较好疗效。

ObjectiveTo summarize the effectiveness of modified arterialized venous flaps in repairing soft tissue defect of fingers.MethodsBetween January 2017 and April 2018, 16 patients with soft defects of fingers were treated. There were 12 males and 4 females, with an average age of 41 years (range, 24-74 years). One case was resulted from resection of cicatricial contracture and 15 cases was caused by mechanical strangulation. The defects located at thumb in 3 cases, index finger in 5 cases, middle finger in 4 cases, ring finger in 2 cases, and little finger in 2 cases; and at the palmar aspect in 4 cases, and dorsal aspect in 12 cases. The size of defect ranged from 3 cm×2 cm to 10 cm×3 cm. All flaps were harvested from the palmar aspect of the ipsilateral forearm. The distal ports of the two veins were ligation. Partial fat was eliminated and the all connecting minute branches between the two veins were ligation under microscope in order to achieve the thorough shunt restriction. Then the flaps were positioned over the recipient site without inversion. The size of flap ranged from 2.5 cm×2.0 cm to 10.0 cm×3.0 cm. All donor sites were directly sutured except 1 case was recovered with free skin graft.ResultsAll flaps survived entirely except 1 case happened vein crisis. Three flaps demonstrated mild-to-moderate venous congestion without any treatment and the swelling of flaps gradually subsided after 1 week. Skin grafting at donor site survived and all incisions healed by first intension. Thirteen patients were followed up 8-16 months (mean, 11 months). The textures and appearances of the flaps were satisfactory. At last follow-up, the mean size of the Semmes-Weinstein (SW) monofilament test of the flaps was 4.01 g (range, 2.83-4.56 g); the mean static two-point discrimination of the flaps was 12 mm (range, 6-20 mm).ConclusionModified arterialized venous flaps with thoroughly restriction of arteriovenous shunting can offer decreased congestion of venous flaps and improve survival rate. Better effectiveness can be achieved using this flap to repair soft tissue defect of finger.

关键词: 动脉化静脉皮瓣; 手指; 软组织缺损; 创面修复; 改良术式

Key words: Arterialized venous flap; finger; soft tissue defect; wound repair; modified method

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