手部加长血管蒂皮瓣修复手指中节以远软组织缺损

Repair of the soft tissue defect distal to the middle segment of finger with the lengthened vascular pedicled flaps in hand

目的介绍两种手部加长血管蒂皮瓣的切取方法及临床修复手指中节以远软组织缺损的经验。方法2002年6月至2004年4月,对6例示、中指中节以远皮肤软组织缺损的病例,应用手背U-I形血管蒂岛状皮瓣进行修复,皮瓣面积最大5.0cm×2.8cm,最小3.8cm×2.5cm,蒂长平均8.0cm。对10例2～4指中节以远皮肤软组织缺损的病例,应用邻指指动脉逆行岛状皮瓣进行修复,皮瓣面积最大4.6cm×2.5cm,最小2.5cm×2.4cm,蒂长平均4.0cm。16例中,男11例,女5例;年龄18～42岁,平均26岁。结果16例皮瓣全部成活,术后随访8～24个月,平均15个月。皮瓣血运、质地及弹性良好,外形满意。经严格功能锻炼,伤指远侧指间关节活动范围20°～60°(平均42°),近侧指间关节、掌指关节活动范围正常。手背U-I形血管蒂岛状皮瓣共吻合神经4例,两点分辨觉恢复为9～11mm。邻指指动脉逆行岛状皮瓣共吻合神经9例,两点分辨觉恢复为6～8mm。未吻合神经者共3例,皮瓣感觉仅恢复至S2～S3。结论手背U-I形血管蒂岛状皮瓣和邻指指动脉逆行岛状皮瓣均可形成较长的血管蒂,用于修复手指中节以远软组织缺损。皮瓣血运良好,安全可靠,可通过吻合神经形成有感觉的皮瓣。

Objective To introduce the procedure and the clinical experience of two lengthened vascular pedicled flaps in hands to repair soft tissue defect distal to the middle segment of finger. Methods From June 2002 to April 2004, 6 cases with skin and soft tissue defect distal to the middle segment of index and middle finger were treated by the dorsal hand U-I shaped vascular pedicled island flaps, the large area of the repair flap was 5.0 cm×2.8 cm, and the small area was 3.8 cm×2.5 cm, an average of the pedicle length was 8.0 cm. 10 cases with skin and soft tissue defect beyond the middle segment of 2 to 4 finger were treated by the digital artery reversed island flaps of adjacent digit, the large area of the repair flap was 4.6 cm×2.5 cm, and the small area was 2.5 cm×2.4 cm, an average of the pedicle length was 4.0 cm. There were 11 males and 5 females, aged from 18 to 42 years (average, 26 years). Results All flaps survived in 16 cases. After 8 to 24 months postoperative follow-up, with an average of 15 months, the blood supply and texture of the flaps were excellent, their outer aspect and function were satisfactory. Among 4 cases of the dorsal hand U-I shaped vascular pedicled island flaps with connecting nerves, the two-point discrimination was 9 to 11 mm, while in 9 cases of the digital artery reversed island flaps with connecting nerves, the two-point discrimination was 6 to 8 mm. Of the 3 cases that the nerves were disconnected, the sensation of the healed flaps only recovered to S2 or S3. Conclusion The dorsal hand U-I shaped vascular pedicled island flaps and the digital artery reversed island flaps of adjacent digit can form a longer vascular pedicle, to repair the skin and soft tissue defect distal to the middle segment of finger. They are the reliable flaps with good blood supply, and can recover the sensation through connecting nerves.