应用骨间后动脉单一穿支微型皮瓣修复手指皮肤缺损

Repair of skin defect of the finger by posterior interosseous perforator mini flap

目的应用骨间后动脉单一穿支微型皮瓣对手部较小面积的皮肤软组织缺损进行精确的定点修复。方法在前臂背侧中部,以骨间后动脉(骨间总动脉尺侧肌皮支)为轴线,用多普勒血流探测仪确定穿支部位后以此设计皮瓣。对24例手指皮肤软组织缺损的患者,应用单一穿支微型皮瓣进行修复,并对皮瓣的设计、切取、吻合、成活特点及治疗效果进行观察和探讨。结果术后21例皮瓣顺利存活,3例皮瓣术后1～3 d出现不同程度的水疱、暗紫、结痂,2例皮瓣脱痂后成活,1例坏死。术后17例获得5～17个月的随访,7例失访。皮瓣外形满意,手指修复后效果良好。3例缝合伴行神经、皮下神经者,Dellon试验达5～6mm。结论骨间后动脉单一穿支微型皮瓣游离移植可对手部较小的皮肤软组织缺损进行精确的定点修复,并获得了较好的临床效果。

Objective To apply posterior interosseous perforator mini flap for accurate repairing of small soft tissue defects of the hand. Methods Doppler detection of the presence and site of the posterior interosseous perforator along the axes of the posterior interosseous artery was carried out in the dorsum of the forearm. The flap was then designed around the perforator site. 24 cases of soft tissue defects in the fingers were treated by this flap. The design, dissection, anastomosis, survival characteristics and treatment outcome were observed. Results 21 flaps survived uneventfully. 3 flaps had signs of circulation crisis postoperatively for a few days. One flap was lost due to complete necrosis. 17 cases had 5 to 17 months＇ follow-up while 7 cases were lost to long-term follow-up. The appearance of the flaps was satisfactory. Movement of the fingers was good. 3 sensate flaps in which the cutaneous nerve was sutured recovered 2-PD of 5 to 6 ram. Conclusion For small skin defects of the hand posterior interosseous perforator mini flap coverage is a good treatment option.