摘要
目的探讨游离腓肠内侧动脉穿支皮瓣修复手背软组织缺损的临床效果。方法采用回顾性病例系列研究分析2018年5月至2020年3月遵义医科大学附属医院收治的12例手背软组织缺损患者临床资料,其中男7例,女5例;年龄24~56岁[(38±9)岁]。创面位于掌背侧9例,面积3 cm×4 cm^4.5 cm×13 cm。创面位于指背侧3例,累及单个手指1例,累及2个手指2例。于小腿内后侧设计腓肠内侧动脉穿支皮瓣,其中皮瓣采用单穿支5例,2个穿支5例,3个穿支2例。皮瓣切取后修复手背创面,其中采用分叶皮瓣2例,皮瓣供区直接缝合。观察皮瓣是否成活、外观、质地、Weber两点辨别觉试验。采用中华医学会手外科学会上肢功能评定试用标准评定掌指和指间关节伸屈功能。观察小腿供区并发症情况。结果患者均获随访6~20个月[(10±1)个月]。皮瓣全部成活,皮瓣外形、质地良好,皮瓣形成保护性感觉,两点辨别距离5.0~6.5 cm。掌指及指间关节伸屈功能评分:掌指关节4.1~5.0分,近指关节3.1~4.0分,远指关节2.1~3分。皮瓣供区仅残留线装瘢痕,对小腿功能无影响。结论腓肠内侧动脉穿支恒定,对供区损伤小,术后皮瓣成活率高、手功能恢复满意,是修复手背软组织缺损的较好选择。
Objective To explore the clinical effect of free inrdicil sural arteiy perforator flap in treatinenl of dorsal soft tissue defects of the hand.Methods A retrospective case series study was used to analyze clinical data of 12 patients with soft tissue defects in the dorsum of the hand admitted to Affiliated Hospital of Zunyi Medical University from May 2018 to March 2020.There were 7 males and 5 females,with the age of 24-56 years[(38±9)years].The wound was located on the back of the palm in 9 patients,with an area of 3 cm x 4 cm-4.5 cm x 13 cm.The wound was located on the back of the finger in 3 patients,with one finger involved in 1 patient and two fingers involved in 2 patients.The medial sural artery perforator flap was designed on the medial and posterior side of the leg.The Hap includrd single perforator in 5 patients,2 perforators in 5 patients,and 3 perforators in 2 patients.After the skin flap was harvested,the wound on the dorsum of the hand was repaired.Among them,2 patients were repaired using the leaflet skin flap.The skin flap donor area was sutured directly.The flap's survival,texture and appearanee was observed.The Weber two-point disciiinination was measured.The extension and flexion scores of the inetcicarpoplialangeal and inter phalangeal joints were evaluated by the evaluation standard of upper limb fuiu tion by society of hand surgeiy of Chinese Medical Association.The complications of the donor site was detected.Results All patients were followed up for 6-20 months[(10±1)months].All flaps survived with good appearance and texture.The distance between the two points was 5.0-6.5 cm.Regarding the score of extension and flexion function of the metacarpophalangeal and inlerphakuigeal joints,the metacarpophalangeal joint was 4.1-5.0 points,the proximal finger joints was 3.1-40points,and the distal finger joints was 2.1-3 points.A linear scar remained at the donor area,but had no effect on leg function.Conclusion The medial sural artery has the tulvciiitagrs of constant perforation,little daiiuigr to the donor site,high flap survived rate after surgery and satisfactory recovery of hand function,suggesting a good choice for trealmrnt of soft tissue defects on the dorsum of the land.
作者
金文虎
张子阳
吴祥奎
邓呈亮
祁建平
魏在荣
王达利
Jin Wenhu;Zhang Ziyang;Wu Xiangkui;Deng Chengliang;Qi Jianping;Wei Zairong;Wang Dali(Department of Plastic Surgery and Burns,Affiliated Hospital of Zunvi Medical University,Zunyi 563003,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2020年第12期1090-1095,共6页
Chinese Journal of Trauma
关键词
手损伤
软组织损伤
外科皮瓣
穿支皮瓣
Hand injuries
Soft tissue injuries
Surgical flaps
Perforator flaps
