背侧骨间动脉逆行岛状皮瓣皮支血管的临床分型及应用体会

Clinical classification of the cutaneous perforatoring artery and application of the reversed dorsal interosseous artery-based island flap from the forearm

目的 介绍背侧骨间动脉逆行岛状皮瓣皮支血管的临床分型及意义.方法 1990年～2008年,我院利用背侧骨间动脉逆行岛状皮瓣转移修复手部软组织缺损共300例,其中,因术中血管变异或手术误伤穿支放弃12例.根据背侧骨间动脉所发出皮支浅出的部位及浅出间隙,将皮支血管分为6型：近侧型12例,均匀型122例,远侧型132例,弥散缺如型12例,皮支代偿型8例,混合型14例.结果 除12例放弃外,其余均行背侧骨间动脉逆行岛状皮瓣修复术,术后258例皮瓣顺利成活,30例出现各种类型并发症.其中14例出现动脉供血不足,保守治疗后皮瓣完全坏死4例、部分坏死10例：10例出现静脉回流受限,经拆除缝线,完全成活;6例出现拇指背伸障碍,再次腱转位重建拇伸功能.结论 骨间背侧动脉逆行岛状皮瓣皮支血管存在变异,术中应根据皮支血管的临床分型,灵活选择相应手术方案,避免供区并发症,提高手术的成功率.

Objective To introduce a clinical classification and significance of the cutaneous perfbratoring arteries in the application of reversed dorsal interosseous artery-based island flap from the forearm. Methods From 1990 to 2008, 300 patients with the soft tissue defects of the hands were treated in our unit. In this series, 288 patients received reversed dorsal interosseous artery-based island flap transfer. Other 12. patients were treated with other techniques due to either vascular variation or iatrogenic perforatoring artery injury during dissection. Based on the anatomic variation of the perforatoring arteries and the septa their passing through, the arteries of the series were classified into proximal （n=12）, even （n=122）, distal （n=132）, dispersed or absent （n=12）, compensation （n=8）, and composite types （n=14）. Reslflts In the 288 cases, 258 flaps were survived uneventfial. In other 30 cases, insuflficient blood supply, venous congestion, arterial compromise, and complete or partial flap necrosis were observed. Fourteen flaps with insufficient blood supply were treated conservatively and developed to complete and partial flap necrosis in 4 and 10 cases, respectively. Ten flaps with venous congestion were survived completely after removal of partial suture. Loss of extension of the thumb was noted in 6 cases, which was treated with tendon transfer. Conclusion Flap design and transfer based on the anatomy of the cutaneous perforatoring artery raised from the dorsal interosseous artery is critical for survival and prevention of the possible postoperative complications