游离足背皮瓣静脉桥接术修复断掌指

Free dorsalis pedis flap transfer combined with vein grafting for treatment of finger and palm severance

目的探讨应用游离足背皮瓣修复手背皮肤软组织缺损，同时利用皮瓣浅表静脉桥接断掌指静脉回流的临床疗效。方法对4例手掌指部离断伴有手背软组织缺损的患者，采用吻合桡动脉的游离足背皮瓣修复，同时利用足背浅表静脉桥接解决断掌、指的静脉回流，皮瓣切取面积为6cm×6cm～11cm×9cm。其中1例携带第3,4趾趾长肌腱，2例因掌指关节面损伤严重伴缺损行掌指关节融合，2例动脉缺损行静脉移植。结果4例12指及4块皮瓣全部顺利存活，伤口工期愈合。术后随访3，18个月，平均12个月，所有手指、皮瓣外观良好，无臃肿，皮肤质地、色泽接近正常，温痛觉及触觉恢复；供瓣区、供皮区均无明显瘢痕形成。按中华医学会手外科学会手部功能评定标准评定：优1例，良2例，可1例；优良率为75％。供区无明显并发症发生。结论应用游离足背皮瓣静脉桥接术是解决断掌，指静脉缺损的一种有效治疗手段。

Objective To evaluate the clinical results of finger or palm replantation using free dorsalis pedis flap transfer to resurface soft tissue defect of the dorsal hand and anastomosing flap superficial veins to drain the replants. Methods Four cases of palm or finger severance combined with soft tissue defect of the dorsal hand were treated with dorsalis pedis flap transfer supplied by the radial artery. The superficial veins in the dorsalis pedis flap were anastomosed and grafted between the reattached finger or palm and its proximal counterpart to facilitate venous drainage. The area of the flaps ranged from 6 cm× 6 cm to 11 cm × 9 cm. In one case the third and fourth extensor digitorum longus tendons were included in the flap. In two cases the metacarpophalangeal joints were fused due to severe damage of the joint. Vein graft was necessary in two cases due to artery defect. Results Twelve fingers in 4 case and all 4 free flaps survived uneventfully. Primary wound healing was achieved. Postoperative follow-up period ranged from 3 to 18 months, with an average of 12 months. The appearance of the replanted fingers and transferred flaps was good. There was no bulkiness. The color and texture of the flaps were near normal. Pain, touch and temperature sensation had recovered. There was no obvious scar formation at the donor site. According to the hand function evaluation criteria, the hand function was graded as excellent in 1 case, good in 2 cases, and fair in 1 case. The overall excellent and good rate was 75%.There were no obvious complications of the donor site. Conclusion Using superficial veins in dorsalis pedis flap transfer to bridge vein defect is an effective treatment method in finger or palm replantation with soft tissue defect.