桡动脉掌浅支腕横纹游离皮瓣修复指背复合组织缺损的临床治疗效果

Clinical effect of free flap from superficial palmar branch of the radial artery for repairing compound tissue defect of finger dorsum

目的探讨桡动脉掌浅支腕横纹游离皮瓣修复指背复合组织缺损中的临床效果。方法回顾性分析2015年1月至2019年6月徐州仁慈医院手外科收治的手指背侧皮肤软组织肌腱缺损伴或不伴骨外露的患者临床资料。采用桡动脉掌浅支腕横纹游离皮瓣进行修复,手指背侧创面缺损长度未超过2.5 cm的患者,选择皮瓣内携带掌长肌腱修复,皮瓣切取和手指背侧修复的方向保持一致;手指背侧创面缺损长度超过2.5 cm时,皮瓣内不携带掌长肌腱,切取桡动脉掌浅支腕横纹皮瓣的同时,沿同一切口下游离掌长肌腱修复。将切取后的皮瓣90°逆时针(左腕部供区)或顺时针(右腕部供区)旋转,覆盖指背创面。腕部供区均直接缝合。术后随访观察皮瓣成活、皮瓣质地情况等,手指关节总活动度(TAM)参考中华医学会手外科学会上肢部分功能评定试用标准评定。结果共纳入17例患者,男12例,女5例;年龄21~65岁,平均39.5岁。左手指10例、右手指7例。指背皮肤缺损面积为1.5 cm×1.3 cm~3.8 cm×2.0 cm,皮瓣切取面积1.8 cm×1.5 cm~4.0 cm×2.2 cm。术后随访3~48个月,平均16.5个月,17例患者皮瓣全部成活且术后愈合良好,皮瓣质地好,未见明显臃肿。其中1例术后18 h出现静脉危象,通过拆线,皮瓣边缘放血,10 d后皮瓣成活。供区术后愈合良好,腕关节屈伸功能无异常。手指TAM评定:优12例,良4例,可1例。结论桡动脉掌浅支腕横纹游离皮瓣修复指背侧皮肤复合组织缺损是一种可供选择的治疗方案,受区皮瓣外形无臃肿,可重建伸指功能,供区损伤小且伤口可直接闭合。

Objective To investigate the effect of free wrist crease flap based on the superficial palmar branch of radial artery in the treatment of compound tissue defect of dorsal finger.Methods From January 2015 to June 2019,the clinical data of patients admitted to the Department of Hand Surgery,Xuzhou Renci Hospital with skin,soft tissue and tendon defects of dorsal fingers,with or without bone exposure,were retrospectively analyzed.The free wrist crease flap based on the superficial palmar branch of radial artery was used.For patients with dorsal finger wounds less than 2.5 cm in length,palmaris longus tendon was used in the flap to repair,and the direction of flap incision and dorsal finger repair was consistent.If the length of dorsal finger defect was more than 2.5 cm,the palmaris longus tendon was not carried in the flap.The wrist crease flap based on the superficial palmar branch of the radial artery was harvested,and the free palmaris longus tendon was used to repair the defect along the same incision.The flap was selected according to the left and right wrist donor site flap and rotated 90°counterclockwise or clockwise to cover the dorsal finger wound.The flap survival and texture were followed up after operation.The total active movement(TAM)of fingers was evaluated according to the trial standard for the evaluation of the upper limb function of the Hand Surgery Society of the Chinese Medical Association.Results A total of 17 patients were enrolled in this study,including 12 males and 5 females.The mean age was 39.5 years(range,21-65 years).There were 10 cases of left finger and 7 cases of right finger.The area of dorsal finger skin defects ranged from 1.5 cm×1.3 cm to 3.8 cm×2.0 cm,and the area of flap ranged from 1.8 cm×1.5 cm to 4.0 cm×2.2 cm.The patients were followed up for 3 to 48 months,with an average of 16.5 months.All the flaps survived and healed well.The texture of the flap was good,and no obvious swelling was observed.Venous crisis occurred in 1 case 18 hours after operation.The stitches were removed,the edge of the flap was bled,and the flap survived after 10 days.All wrist donor sites were sutured directly and healed well after operation.There was no abnormality in wrist flexion and extension function.The TAM of fingers was rated as excellent in 12 cases,good in 4 cases,and fair in 1 case.Conclusions The free wrist crease flap based on the superficial palmar branch of radial artery is an alternative method for repairing compound tissue defect of dorsal finger.The recipient flap has no bloated appearance.Finger extension function could be reconstructed.The wound at the donor site is small and could be closed directly.