股前外侧皮瓣游离移植一期修复手掌心毁损创面并重建掌浅弓

One-stage repair of mutilated palm and the superficial palmar arch with anterolateral thigh flap transfer

目的 探讨应用股前外侧皮瓣游离移植一期修复手掌心毁损创面并重建掌浅弓的临床疗效.方法 2005年3月至2009年12月,对6例手掌心毁损创面应用股前外侧皮瓣游离移植,并重建掌浅弓血管.术中仔细解剖皮瓣及血管蒂,形成以旋股外侧动脉外侧降支为主干及多个分支的血管链,以及以第一穿支为蒂的股前外侧皮瓣.其中皮瓣覆盖创面,血管链及各分支重建掌浅弓,以恢复各手指的血供.结果 术后6例均保留了手掌及手的完整性,皮瓣全部存活,其中1例环指坏死行截指,1例小指远节残端修复,其余各手指血运良好,2例进行二期功能重建与皮瓣修薄手术.随访时间为6～12个月,按中华医学会手外科分会上肢部分功能评定试用标准评定：良3例,可2例,差1例.结论 应用股前外侧皮瓣游离移植一期修复手掌心毁损创面并重建掌浅弓手术,临床效果满意,可以最大限度地减少截指的发生.

Objective To investigate the clinical results of one-stage coverage of mutilated palm wound and reconstruction of the superficial palmar arch with anterolateral thigh flap transplantation. Methods From March 2005 to December 2009, 6 cases with mutilating palm injury underwent anterolateral thigh flap transfer to resurface the palmar wound and reconstruct the superficial palmar arch at the same time. The flap and vascular pedicle were dissected carefully to form a vascular chain composed of the trunk of the lateral descending branch of lateral circumflex femoral artery and several muscular branches, and the anterolateral thigh flap pedicled on the first perforator. The flap was inset to cover the wound while the vascular chain with its branches was anastomosed to the superficial palmar arch to restore blood circulation to the fingers. Results Postoperatively all free flaps survived. The integrity of the palm and hand was retained. Other than necrosis of the ring finger in 1 case that was amputated and the little finger in 1 case that required revision, all the fingers recovered good blood circulation. Secondary functional reconstruction and flap debulking were carried out in 2 cases. After 6 to 12months of follow-up the results were graded as good in 3 cases, fair in 2 cases, and bad in 1 case according to the provisional functional assessment criterion for upper limbs issued by the Chinese Hand Surgery Society.Conclusion One-stage coverage of mutilated palm wound and reconstruction of the superficial palmar arch with anterolateral thigh flap transplantation leads to satisfactory clinieal results and minimizes the incidence of finger amputation.