指动脉岛状皮瓣的设计类型和临床应用

Digital artery island flap: types and clinical application

目的:设计10种以指动脉为轴型血管的岛状皮瓣,为修复指部不同创面提供合适术式。方法:用顺行、逆行带蒂,三角皮瓣推移及游离移植4种指固有神经血管岛状皮瓣,修复15例(20瓣);顺行、逆行带蒂,逆行桥式交叉转移3种指固有神经背侧支岛状皮瓣,修复8例;顺行、逆行带蒂,逆行桥式转移3种指动脉岛状皮瓣,修复5例。结果:33块皮瓣全部成活,逆行转移时,蒂部附加三角瓣的设计保证了转移时血管蒂不受压;桥式交叉转移时,附加矩形瓣的设计可保证一期闭合蒂部创面。结论:指固有神经背支岛状皮瓣是最理想的皮瓣类型,逆行转移是修复指端缺损的理想转移方式。

<Abatract>Objective: Ten types of digital artery island flap was designed for the skin defects on the digits. Methods: The techniques included pedicle, reverse pedicle, free and advancing flaps with proper digital nerve and vessel in 15 cases (20 flaps), pedicle, reverse pedicle, cross flaps with dorsal branch of proper digital nerve in 8 cases, and pedicle, reverse pedicle and cross flaps with digital artery in 5 cases. Results: All the 33 flaps survived. A triangle flap was designed on the cutaneous pedicles for avoiding compress the vessel pedicles in reversed transfer. A rectangle flap was designed on the pedicles so that the wound on the pedicles could be closed primarily in cross transfer. Conclusions: The idealest type of digital artery island flap is the flap with dorsal branch of digital nerve. The reversed transfer is the best transfer method for fingertip defect.