足背复合皮瓣在手部复合损伤中的应用

The application of composite dorsalis pedis flap in reconstruction of hand function

目的 介绍用足背复合皮瓣修复手背软组织伴多条指伸肌腱缺损的临床经验。方法 1991年 11月至 1998年 9月 ,用带趾长伸肌腱和腓浅神经足背内侧 (或中间 )皮支的足背复合皮瓣 ,修复手背复合组织缺损 15例。足背供区用带真皮下血管网游离皮片覆盖。结果 经过平均 4.5年的随访 ,移植皮瓣全部成活 ,感觉恢复至S2～ 3 级。患手掌指关节活动度从术前的 2 0° (平均 )增加至 60° (平均 ) ,恢复了部分抓、握功能。供足足背外形饱满无凹陷 ,植皮区耐摩、耐压 ,行走良好。结论 足背复合皮瓣移植是修复手部复合组织缺损的较好方法。

Objective To introduce the clinical experience of using composite dorsalis pedis flap for repair of soft tissue defect of the dorsum of the hand combined with multiple extensor tendon defect. Methods From November 1991 to September 1998,the dorsalis pedis composite flap was used to repair complex tissue defect on dorsum of the hand in 15 cases. The composite flap hosted the extensor digitorum longus tendon and the dorso medial or dorso middle cutaneous branch of the superficial peroneal nerve. The donor site on dorsum of the foot was covered by free skin graft with subdermal vascular network. Results All the transplanted flaps survived. After 4.5 years follow up, the sensation of the flap was found to be graded S 2 S 3. The average range of motion of the metacarpophalangeal joint increaed from 20° preoperatively to 60° postoperatively. Grasp and grab function was restored to some extent. The appearance of the donor foot was plump. There was no ulceration of the skin graft. Walking function of the foot was normal.Conclusions Dorsalis pedis composite flap transplantation is a good procedure for repair of complex tissue defect of the hand.