摘要
目的探讨游离胫前动脉近端骨膜穿支骨皮瓣修复拇指节段性缺损的临床疗效。方法2013年3月至2019年1月,应用胫前动脉近端骨膜穿支骨皮瓣移植修复拇指节段性缺损8例。其中,指骨间关节段缺损2例,近节指骨缺损3例,鱼际肌及掌骨段缺损3例;合并肌腱缺损4例,同时伴有其他指损伤6例。软组织缺损面积:4.5 cm×2.5 cm^7.2 cm×4.0 cm,指、掌骨缺损长度:1.2~2.5 cm。皮瓣切取面积:5.0 cm×3.0 cm^7.5 cm×4.5 cm,骨瓣切取大小:1.2 cm×1.0 cm×0.8 cm^2.5 cm×1.0 cm×1.0 cm。供区创面直接缝合或皮瓣局部转移覆盖6例,植皮2例。术后制定随访计划,所有病例采用门诊、电话、微信及登门拜访相结合的方法进行随访。结果术后骨皮瓣全部成活。随访6~24个月,皮瓣色泽正常,质地良好,厚薄适中,TPD为7~10 mm。小腿供区无功能影响。移植骨瓣愈合时间2.0~4.0个月,平均2.6个月。依中华医学会手外科学会上肢部分功能评定试用标准评定:优7指,良1指;采用Michigan手功能评价标准评定,8例8指评分81.3~91.8分,平均83.6分。结论应用胫前动脉近端骨膜穿支骨皮瓣重建拇指节段性缺损,能够较大程度恢复拇指的外观和功能,且供区损害小,是拇指节段性缺损修复的有效术式。
Objective To investigate the clinical effect of free anterior tibial artery proximal periosteal perforator bone-skin flap for repairing phased thumb defect.Methods Eight patients of phased defect of thumb were repaired from March,2013 to January,2019 utilizing proximal tibial artery periosteal perforator bone and skin flap.Of which,2 cases suffered defects at interphalangeal joint of thumb,3 in proximal phalanx,and 3 at thenar muscle and metacarpale.There were 4 cases with tendon defect,6 cases with other finger injuries.The areas of soft tissue defect was 4.5 cm×2.5 cm to 7.2 cm×4.0 cm,and the length of metacarpale bone defect was 1.2 to 2.5 cm.The flap size ranged from 5.0 cm×3.0 cm to 7.5 cm×4.5 cm,and the bone flap size was 1.2 cm×1.0 cm×0.8 cm to 2.5 cm×1.0 cm×1.0 cm.Six cases received direct suture or local skin metastasis in anterior tibial region and 2 cases with skin grafting.All patients were followed-up by clinic visits,telephone or WeChat reviews,and home visits.Results All the flaps survived after surgery.A 6 to 24 months followed-up showed that the flaps were normal in colour with good texture and moderate thickness.TPD of the flaps ranged from 7 to 10 mm.The donor site of the shank had good appearance and were in normal function,and the walking were not affected.Healing time of transplanted bone flaps ranged from 2.0 to 4.0 months,with an average of 2.6 months.According to the Evaluation Criteria of Upper Limb Function of the Hand Surgery Society of Chinese Medical Association,the results were excellent in 7 thumbs and good in 1 thumb.According to Michigan Hand Function Evaluation Criteria,8 thumbs scored 81.3 to 91.8 points,with an average of 83.6 points.Conclusion The reconstruction of phased defect of thumb with proximal tibial artery periosteal perforator bone-skin flap can restore the appearance and function of thumb to the greatest extent,and the affect to donor site is minimum.It is an effective surgical method for repairing phased defect of thumb.
作者
魏义涛
伍仁娟
梅雄军
梁海华
WEI Yitao;WU Renjuan;MEI Xiongjun;LIANG Haihua(Department of Hand and Foot Microsurgery,Xin'an Hospital of Chang'an Town,Dongguan,Guangdong Province 523880,China;Department of Anesthesia,Xin'an Hospital of Chang'an Town,Dongguan,Guangdong Province 523880,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2020年第3期257-260,共4页
Chinese Journal of Microsurgery
基金
2019东莞市社会科技发展(一般)项目(2019507150116151)。
关键词
胫前动脉
穿支
骨皮瓣
节段性拇指缺损
修复
Anterior tibial artery
Perforator
Bone-skin flap
Phased
defect of thumb
Repair
