吻合血管的阔筋膜瓣联合肋骨及皮片移植修复手指末节缺损

Reconstruction of distal phalanx defect with microsurgical fascia latae flaps combined with rib and skin graft

目的总结吻合血管的阔筋膜瓣联合肋骨及网状皮片移植修复手指末节骨及软组织缺损的临床应用效果。方法将伤指缝合在一起，呈并指状，使各指创面连为一体，然后，切取自体肋骨段，将其修剪成与指骨类似的形状后，移植于手指末节修复骨缺损，将所取阔筋膜瓣的血管蒂与受区的血管行端端吻合，在阔筋膜上移植中厚网状皮片。结果2003年8月至2006年6月，于临床应用本法修复5例，阔筋膜瓣全部成活，仅1例术后发生远端小面积皮片坏死，经换药后逐渐自行愈合。结论阔筋膜瓣以旋股外侧动脉降支为血供，血运丰富、血管解剖恒定、血管蒂长、切取容易，联合肋骨及皮片移植很适宜修复手指末节缺损。

Objective To evaluate the clinical application of microsurgical fascia latae flaps combined with rib and skin graft for reconstruction of the distal phalanx defect. Methods The phalanx wounds were sutured together like syndactyly. The autologeous rib was revised to repair the bone defect of distal phalanx. The fascia latae flap was used to cover the bone exposure with microvascular anastomoses and resudaced by a meshed split-thickness skin graft. Results 5 cases were treated successfully. The fascia latae flaps were all survived with ordy skin graft necrosis at the distal end in one case. It was healed spontaneously. Conclusions The fascia latae flap is nourished by the desending branch of the lateral circumflex femoral artery. The flaps has a good blood supply and can be easily obtained with a long vascular pedicle. The flap is ideal for the reconstruction of distal phalanx defect when combined with autologeous rib implant and skin graft.