游离皮瓣移植修复手部及前臂皮肤缺损407例分析

Repair of skin defect of the hand and forearm by free flaps:analysis of 407 cases

目的探讨游离皮瓣移植修复手部及前臂皮肤缺损的疗效。方法1990年5月—2005年9月,选用18种游离皮瓣移植修复手部及前臂皮肤缺损407例。其中(足母)趾腓侧趾腹皮瓣39例,(足母)趾或第二趾趾甲瓣11例,(足母)甲瓣或第二趾趾甲皮瓣60例,(足母)趾腓侧半月形皮瓣6例,(足母)趾腓侧或第二趾胫侧半侧甲瓣7例,足背三叶或二叶皮瓣6例,带足背皮瓣的足趾移植144例,第一趾蹼皮瓣12例,足底内侧皮瓣4例,足背皮瓣10例,足外侧皮瓣8例,小腿内侧皮瓣21例,小腿外侧腓骨皮瓣2例,肩胛皮瓣2例,股前外侧皮瓣9例,胸脐皮瓣27例,背阔肌皮瓣5例,桡动脉皮瓣5例,(足母)甲瓣或第二趾与游离皮瓣组合移植29例。结果术后成功401例,成功率为98．5%。术后经6个月～8年(平均3．5年)的随访,皮瓣血运、质地、弹性良好。不同类型的足趾组织瓣或足部皮瓣移植修复后的拇、手指外形良好,指腹两点分辨觉为5至8mm。结论游离皮瓣移植是修复手部及前臂皮肤缺损的理想方法之一。尤其对拇手指皮肤缺损,选用不同类型的足部游离皮瓣移植修复,功能与外形优于其他方法。

Objective To evaluate the outcome of using 18 types of free flaps for coverage of skin defect in the hand and forearm. Methods From May 1990 to Sept 2005, 18 types of free flaps were used to repair skin defect of the hand and forearm in 407 patients. There were 39 cases of pulp flap from the great toe, 11 cases of onychoeutaneous flap from the great or second toe, 60 cases of wrap-around flap of the great or second toe, 6 cases of semi-lunar flap from fibular side of proximal segment of the great toe, 6 cases of bifoliated or trifoliated flap from the dorsum of the foot, 144 cases of great or second toe combined with dorsalis pedis skin flap, 12 cases of free first toe web flap, 4 cases of medial plantar skin flap, 10 cases of dorsalis pedis skin flap, 8 cases of lateral skin flap of the foot, 21 cases of medial lower leg flap, 2 cases of fibular osteoeutaneous flap, 2 cases of parascapular flap, 9 cases of antero-lateral thigh flap, 27 cases of umbilico-costal flap, 5 eases of latissimus dorsi myoeutaneous flap, 5 eases of radial forearm flap, and 29 eases of combined transplantation of wrap-around flap of the great toe, second toe and free flap. Results Of the 407 eases, 401 transplants survived and the successful rate was 98.5%. Follow-up examination made from 6 months to 8 years postoperatively showed that the blood-supply, texture and elasticity of transferred flaps were exceUent. The outward appearance of thumb and fingers repaired by different types of foot flaps was good. Two paint discrimination of the pulp was 5 - 8 mm. Conclusion Transplantation of free flap for repair of skin defect in the hand and forearm is an ideal option, especially for thumb and finger skin defect cases. Transfer of appropriate type of free flaps harvested from the foot for individual case showed to yield better result than other methods in regard to restoration of function and outward appearance.