轴型皮瓣修复手指软组织缺损

Repair of finger soft tissue defects using axial pattern flaps

目的 观察应用不同轴型皮瓣修复手指软组织缺损的临床效果并探讨其可行性.方法 2005-2010年,对浙江绍兴第二医院收治的30例手指软组织缺损患者,分别应用5种轴型皮瓣进行修复,其中拇指背侧皮神经营养血管远端蒂皮瓣4例、游离足拇趾腓侧皮瓣6例、改良掌背动脉逆行皮瓣8例、游离骨间后动脉桡背侧肌间隔穿支皮瓣6例以及携带长段骨间后动脉的游离骨间后动脉皮瓣6例.皮瓣切取面积2.5 cm ×2.0 cm ～8.0 cm×3.0 cm.供瓣区创面直接缝合或移植皮片修复.观察患者术后皮瓣成活情况,随访患手局部感觉、功能及外形变化. 结果 本组患者中27例术后切口无感染、皮瓣成活良好；2例皮瓣远端部分坏死、1例发生静脉危象,经处理创面愈合.18例患者获得1 ～12个月的随访,皮瓣色泽、质地较好,厚薄适中.大多数患者受区拇指或掌指的外形及功能恢复达预期目的,两点辨别觉为5 ～9 mm;供瓣区外形和功能基本不受影响. 结论 根据手指软组织缺损的具体情况,结合不同轴型皮瓣特点进行优化选择,多能获得预期效果.

Objective To investigate the feasibility and effect of different types of axial pattern flaps in repairing soft tissue defects of the fingers. Methods Five types of axial pattern flaps were used to repair soft tissue defects of the fingers of 30 patients admitted to the Second Hospital of Shaoxing Municipality from 2005 to 2010,including distally-based dorsal thumb neurocutaneous vascular flaps in 4 cases,free flaps from the fibular side of the great toe in 6 cases,modified retrograde dorsal metacarpal artery flaps in 8 cases,free flaps based on the radiodorsal septomuscular perforator of the posterior interosseous artery in 6 cases,and free posterior interosseous artery flaps carrying a long segment of the posterior interosseous artery in 6 cases.The flap size ranged from 2.5 cm × 2.0 cm to 8.0 cm × 3.0 cm.The donor sites were sutured directly or covered with skin graft.The condition of flaps was observed.The local feeling,function,and appearance of affected hands were followed up. Results Twenty-seven flaps grew well without infection.Partial necrosis at the distal portion in two flaps and venous congestion in 1 flap were observed after surgery,and they were healed with suitable treatment.Eighteen patients were followed up for 1 to 12 months.The flaps were found to have good color,texture,and thickness.Satisfactory appearance and function both in the donor sites and in the recipient areas were found in most patients.The sense of two-point discrimination of repaired fingers ranged from 5 to 9 mm. Conclusions Optimizing the repair method for soft tissue defects in the fingers by taking both the characteristics of various axial pattern flaps and the specific conditions of soft tissue defects into account can achieve expected effect.