游离足内侧微型皮瓣修复手指软组织缺损

A free medialis pedis mini-flap pedicled on medial branch of deep branch of the medial plantar artery to repair the soft tissue defect of the finger

目的观察足内侧微型皮瓣游离移植修复手指软组织缺损的临床效果。方法自1997年12月～2003年5月间共为11例13指行游离足内侧微型皮瓣移植,男8例10指,女3例3指,年龄18～58岁,平均32岁。8个皮瓣用于修复手指软组织缺损,其中修复手外伤后手指掌侧皮肤缺损6指,并指畸形分指后手指侧面骨外露1指,电击伤后手指掌侧瘢痕挛缩及屈肌腱缺损1指;5个皮瓣与第二趾甲复合组织瓣联合移植修复手指脱套伤或再造手指,其中外伤后示指中远节脱套伤1指,示、中指全长脱套伤各1指,示指中远节断指再植后坏死2指。皮瓣以足底内侧动脉深支的内侧支为血管蒂,以足舟骨结节的最高点与第一跖骨头胫侧缘连线为轴线,在足内侧设计微型皮瓣,皮瓣的血管蒂分别与指动脉及指背静脉吻合。结果术后随访3个月～5年6个月,平均21个月。本组共行13个足内侧微型皮瓣及5个第二趾甲复合组织瓣游离移植。13个足内侧皮瓣中12个完全成活,1个部分坏死。皮瓣面积最小为2.5cm×3cm,最大为6cm×4cm。3个用于修复指腹缺损的足内侧皮瓣,切取时携带了隐神经的分支并与指神经吻合,术后皮瓣的两点分辨率为7～9mm;其余10个未携带感觉神经。移植后皮瓣的色泽、质地、厚薄与手指皮肤尤其是手指掌侧皮肤相似,再造后的手指外观逼真。

Objective To observe the results of free medialis pedis mini-flap pedicled on medial branch of deep branch of the medial plantar artery to repair a soft tissue defect of finger. Methods The mini-flap designed on the medial side of the foot pedicled on the medial branch of deep branch of medial plantar artery was used to repair the soft tissue defect of finger or the degloved injury of the finger combined with second toe flap, furthermore, the vascular pedicle of flap was anastomosed with the digital artery and dorsal vein respectively. 13 fingers of 11 cases, which included 10 fingers of 8 cases of male and 3 fingers of 3 cases of female with an average of 32 years ranging from 18 to 58 years, were performed 13 free medialis pedis mini-flaps transplantation. Eight free medialis pedis mini-flaps were used to repair the soft tissue defect of the finger, and 5 free medialis pedis mini-flaps combined with the second toe composite flap were used to reconstruct the degloved finger. Results All the patients were followed up on an average of 21 months ranging from 3 months to 5.5 years. The maximal area of flaps was 5 cm×4 cm, and the minimal was 2.5 cm×3 cm. 12 of the 13 free medialis pedis mini-flaps were survived completely, however, 1 healed but partly necrosis. The color, character and thickness of this flap after transplantation were similar to the skin of the finger; and the appearance of the reconstructed finger by mini-medialis pedis flap and second toe composite flap was perfect. The transplanted skin of donated areas survived well, and the appearance and functions of donated feet were not affected significantly. Conclusion The free medialis pedis flap pedicled on medial branch of the deep branch of the medial plantar artery was one of the optimal flaps to repair soft tissue defect of the finger especially on the palmer side.