应用吻合血管的阔筋膜瓣联合游离皮片移植修复手指软组织缺损的经验介绍

Repair of soft tissue defect of the fingers with vascularized fascia lata transplantation combining with free skin graft

目的介绍应用吻合血管的阔筋膜瓣联合游离皮片移植修复手指软组织缺损的经验。方法临床应用５例９指。阔筋膜瓣的面积最大为６ｃｍ×９ｃｍ，最小为２．５ｃｍ×７．０ｃｍ。结果移植的阔筋膜瓣全部成活，植于其上的中厚皮片除２例有小块坏死外，其余也全部成活。术后随访１～４年，除１指的近节指间关节、１指的掌指关节屈曲受限外，其余手指伸屈活动正常，效果满意。结论该筋膜瓣以旋股外侧动脉降支为供血来源，血管解剖恒定，血管蒂长，切取容易。移植后的筋膜皮瓣较薄，适于修复手指软组织缺损。

Objective To introduce the treatment of soft tissue defect of the fingers by vascularized fascia lata transplantation combining with free skin graft. Methods Soft tissue loss of 9 fingers in 5 cases were repaired with this procedure. The largest size of fascia lata harvested was 6 cm 9 cm, while the smallest was 2.5 cm 7 cm . All patients were followed up for 1 to 4 years. Results The transplanted fascia lata survived in all cases. Except for the minor necrosis in 2 cases, the split thickness skin graft survived completely. There was impairment of flexion in the proximal interphalangeal joint of one finger and in the metacarpophalangeal joint of another finger. Movement of the remaining seven fingers was normal. The overall treatment outcome was satisfactory. ConclusionsThe fascia lata fascial flap is nourished by the descending branch of the lateral circumflex femoral artery. It can be easily harvested because of the constant vascular anatomy and the long vascular pedicle. Besides, the flap is thin and is therefore suitable for coverage of soft tissue loss of the fingers.