手背软组织缺损皮瓣修复的临床选择

Clinical choice of flap for repairing soft tissue defects of dorsum of the hand

目的探讨利用三种游离皮瓣及带前臂皮神经营养血管岛状皮瓣修复手背软组织缺损的临床效果。方法采用小腿外侧皮支皮瓣、足背皮瓣、股前外侧皮瓣及带前臂内、外、背侧皮神经营养血管岛状皮瓣，选择性修复手背软组织缺损225例。结果本组174例三种游离皮瓣中170例成活．4例出现血管危象，经及时探查1例皮瓣全部坏死，3例部分坏死：51例前臂皮神经皮瓣．除6例远端部分坏死外，余全部成活。随访6个月～8年．皮瓣质地好，色泽正常，手外形与功能改善满意，痛、深触觉逐渐恢复正常。结论选择性游离皮瓣修复效果普遍优于前臂皮神经营养血管的岛状皮瓣，适于临床开展。

Objective To compare the curative effect of different flap for repairing soft tissue defect of dorsum of the hand. Methods 225 cases with soft tissue defect were repaired by lateral leg flaps, dorsal pedis flap, lateral anterior thigh flap, ulnar forearm flap, radial forearm flap and dorsal forearm flap. The area of soft tissue defects was 5.0cm×6.0cm-10.0cmX 14.0cm, the minimum and maximum area of the flaps was respectively 6.0cm×7.0cm and 12.0cm×16.0cm. Results 174 cases with soft tissue defects of the dorsum of the hand were repaired by 3 types of flee flaps, and 170 flaps survived, postoperative vascular crisis occurred in 4 cases, after prompt exploration, 1 case necrosis, 3 cases segmental necrosis. In 51 cases of neurocutaneous flaps of the forearm, 6 cases segmental necrosis, 45 cases completely survived. Following- up randged from 6 months to 8 years, the texture and the color of the flaps were very well, the outline of the hand and functional results were satisfactory, the painful sensation and deep touch sensation of the flaps exist. Conclusion Among selectivity flaps, the free flap for soft tissue defects of the dorsum of the hand is better than neurocutaneous flaps in curative effect, according to different defects, select different flap to achieve the best result, it is the goal of the reconstruction surgery.