指侧方岛状皮瓣和微型静脉皮瓣的局部解剖及在皮肤缺损型断指再植中的应用

Anatomy and Clinical Application of Finger Side Quadrate Island Flap and Miniature Vein Skin Flap in Replantation of Severed finger with Skin Defect

目的研究指侧方岛状皮瓣和微型静脉皮瓣的局部解剖及在皮肤缺损型断指再植修复中的临床应用。方法分别利用上肢血管铸形标本、前臂取皮手术标本、新鲜废弃手部标本及活体手部体表测量标本等进行应用解剖研究,并在此基础上,按掌侧、背侧及环状缺损3种类型选取皮肤缺损型断指病例18例19指,分别设计指侧方岛状皮瓣、前臂微型游离静脉皮瓣及前2种皮瓣之联合皮瓣3种术式进行再植修复。结果 19指及皮瓣均成活;患指长度无明显短缩,外观良好,移植皮瓣质地良好;患指功能TAM评分:优7指,良9指,差3指,优良率为84.21%。结论指侧方岛状皮瓣和微型静脉皮瓣可灵活应用于各种类型的皮肤缺损型断指的再植修复。

Objective To research the regional anatomy and the clinical application of finger side quadrate island flap and miniature vein skin flap in replantation of severed finger with skin defect.Methods The applied anatomy was studied by using upper limb vessel casting specimens,forearm skin surgical specimens,fresh abandoned hand specimens and in vivo surface hand measurement specimens.According to different defect location（palmar defect,dorsal defect and ring defect）,19 fingers of 18 patients with finger amputation were selected and repaired using finger side quadrate island flap,forearm miniature free vein skin flap and the combined flaps for replanlation of amputated fingers,respectively.Results Skin flaps survived in all cases and the length of repaired fingers did not shortened.The repaired fingers had good appearance and high-quailty skin flaps.TAM showed excellent in 7 fingers,good in 9 and bad in 3.The excellent and good rate was 84.21%.Conclusion Finger side quadrate island flap and miniature vein skin flap can be extensively used in different types of replanlation of amputated finger with skin defect.