胫后动脉穿支骨（膜）皮瓣移植修复手部复合组织缺损

Repairing composite tissue defect of the hand by posterior tibial artery perforator bone （periosteum） flap

目的探讨以穿支血管为蒂胫后动脉穿支骨（膜）皮瓣游离移植修复手部复合组织缺损的方法及疗效。方法对9例外伤性手部骨、皮肤软组织缺损患者，术前行小腿部动脉数字减影血管造影，依据胫后动脉造影结果及解剖特点，选择以胫骨滋养动脉或胫后动脉发出的骨（膜）皮穿支血管为蒂，切取胫后动脉穿支胫骨骨（膜）皮瓣，游离移植修复手部骨和皮肤软组织缺损。骨瓣切取大小为1．5cm×0．6cm×0．4cm。3．5cm×0．7cm×0．5cm。皮瓣切取面积为4．0cm×3．5cm～7．0cm×4．0cm。结果术后9例复合组织瓣完全存活，随访时间为3-18个月，骨缺损植骨处骨折线于术后3—4个月消失，骨折全部愈合。按照中华医学会手外科学会上肢部分功能评定试用标准中总主动活动度（TAM）系统评定法进行关节功能评价，优良率为88．9％，效果满意。结论对于各种原因造成的手部复合组织缺损，采用胫后动脉穿支胫骨骨（膜）皮瓣游离移植修复，不牺牲主干血管，供区与受区血管管径相当，便于血管吻合，组织移植后对供区影响小，骨愈合时间短，是一种较理想的治疗方法。

Objective To study the methods and effects of repairing composite tissue defects of the hand by tmnsfering posterior tibial artery perforator bone （periosteum） flap. Methods Nine cases of traumatic bone and soft tissue defects in the hand underwent digital subtraction angingraphy （DSA） of the lower leg preoperatively. According to angingraphy results and the anatomical characteristics, the tibial nutrient artery or cstecseptocutancous perforator vessel of the posterior tibial artery was selected as vascular pedicle to harvest tibial artery perforator bone （poriosteum） flap. The csteocutaneous flap was transferred to repair the bone and soft tissue defect in the hand. The volume of the harvested bone ranged from 1.5 cm × 0.6 cm ×0. 4 cm to 3.5 cm ×0.7 cm × 0.5 cm. The area of the skin flap ranged from 4.0 cm × 3.5 cm to 7.0 cm ×4.0 cm. Results All the composite tissue flaps survived completely. Postoperative follow-up for 3 to 18 months revealed that the fracture line disappeared in 3 to 4 months and all fractm＇es healed. According to the TAM system of joint function assessment/provisional upper limb function evaluation standard issued by the Chinese Hand Surgery Society, 88.9% of the cases achieved satisfactory results. Conclusion Transfer of posterior tibial artery perforator bone （periosteum） flap is an ideal procedure to repair composite tissue defects of the hand. No major vessel of the donor site is sacrificed. The good size match between the vessels of the donor site and recipient site makes vascular anastomosis easy. Donor site morbidity is minor. Bone healing time is short.