中国修复重建外科杂志

中国修复重建外科杂志

前臂桡背侧穿支皮瓣游离移植修复手指皮肤缺损

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目的探讨前臂桡背侧穿支皮瓣游离移植修复手指皮肤缺损的临床疗效。方法2017 年 1 月—2018 年 5 月,采用以骨间后动脉桡侧分支为蒂的前臂桡背侧穿支皮瓣游离移植修复手指皮肤缺损 26 例。男 21 例,女 5 例;年龄 19~56 岁,平均 26.6 岁。致伤原因:切割伤 16 例,挤压伤 10 例。受伤至入院时间为 30 min~4 h,平均 1.5 h。损伤指别:拇指 6 例,示指 8 例,中指 6 例,环指 3 例,小指 3 例。其中指背侧 6 例,指侧方 6 例,指掌侧 14 例。创面均伴肌腱及骨外露,10 例伴指骨骨折。清创后手指皮肤缺损范围为 2.0 cm×1.0 cm~4.0 cm×2.5 cm。皮瓣切取范围为 2.5 cm×1.5 cm~4.5 cm×3.0 cm。供区均直接缝合。结果患者均获随访,随访时间 4~12 个月,平均 7 个月。其中,24 例皮瓣顺利成活,创面Ⅰ期愈合;2 例皮瓣远端部分坏死,经对症处理后愈合。供区切口均Ⅰ期愈合。皮瓣外形满意,质地柔软。术后 4 个月皮瓣两点辨别觉为 5~10 mm,平均 8 mm;皮瓣感觉恢复 S3。前臂桡背侧供区遗留线样瘢痕。结论前臂桡背侧穿支皮瓣游离移植修复手指皮肤缺损可缩短病程,减低供区损害,提升患者的生活质量

ObjectiveTo investigate the effectiveness of radial-lateral forearm free perforator flap in repair of soft tissue defects in the finger.MethodsBetween January 2017 and May 2018, 26 cases of finger skin defects were treated with radial-lateral forearm free perforator flap based on the radial branch of the posterior interosseus artery. There were 21 males and 5 females, with an average age of 26.6 years (range, 19-56 years). The cause of injury included the cutting injury in 16 cases and crush injury in 10 cases. The interval between injury and admission was 30 minutes–4 hours (mean, 1.5 hours). The injury located at thumb in 6 cases, index finger in 8 cases, middle finger in 6 cases, ring finger in 3 cases, and little finger in 3 cases; and at the dorsum of finger in 6 cases, the lateral side in 6 cases, and the palm in 14 cases. All wounds accompanied with the tendon and bone exposures, and phalangeal fractures occurred in 10 cases. The size of the defects ranged from 2.0 cm×1.0 cm to 4.0 cm×2.5 cm. And the size of the flap ranged from 2.5 cm×1.5 cm~4.5 cm×3.0 cm. All wounds at donor sites were sutured directly.ResultsAll the 26 cases were followed up 4-12 months (mean, 7 months). The 24 flaps survived uneventfully after operation, and the wounds healed at first intention. Partial necrosis occurred at the distal part in 2 flaps. And secondary healing achieved after debridement and dressing. All incisions at donor sites healed at first intention. The appearance and texture of all flaps were satisfactory. Two-point discrimination of the flaps was 5-10 mm (mean, 8 mm) at 4 months after operation. Sensory of the flaps was S3. Only linear scar was noted at the donor site.ConclusionThe radial-lateral forearm free perforator flap in repair of the soft tissues in finger can shorten the course of disease, reduce the damage of the donor site, and improve the patients'quality of life.

关键词: 穿支皮瓣; 皮肤缺损; 游离移植; 手指; 前臂

Key words: Perforator flap; skin defect; free grafting; finger; forearm

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