应用掌背或足部复合皮瓣I期修复手指背部皮肤肌腱缺损

Primary repair of sldn and tendon defects on dorsum of fingers with the composite flaps from palm or foot

【摘要】目的探讨应用掌背或足部复合皮瓣I期修复手指背部皮肤肌腱缺损的手术指征、手术方法和疗效。方法本组10例患者均为机器挤压伤，由热压伤造成手指背侧皮肤软组织缺损，同时伴有伸指肌腱部分缺损。应用带蒂第2或第4掌背动脉复合皮瓣或游离足背复合皮瓣修复。结果术后随访2—18个月，所有皮瓣成活，外形良好；肌腱活动功能根据TAM评分：优6例，良3例，中1例。供区无明显功能障碍。结论带蒂第2或第4掌背动脉复合皮瓣可应用于修复小面积手指背皮肤伴肌腱缺损；游离足背皮瓣可修复中、大面积手指联合手背复合组织缺损或多指复合组织缺损；携带肌腱的复合皮瓣I期修复指背部皮肤肌腱缺损，可减少创伤，缩短疗程，功能恢复良好。

Abstract： Objective To explore the indication, approaches and postoperative effects of skin and tendon defects on dorsum of fingers repaired primarily with the composite flaps from palm or foot. Methods Caused by crush and hot crush injuries, 10 cases with skin and soft tissue defects combined segmental defect of tendon on the dorsum of fingers were repaired with combined flap pedicled with the 2nd or 4th dorsal metacarpal arteries or free flap from dorsum of foot. Results The follow-up study ranged from 2 to 18 months with an average of 6 months. All flaps were survival without bulky appearance. The tendon function was evaluated with total active range of motion. It showed that 6 cases were excellent, 3 cases good and 1 case fair. There was no significant functional impairment of donor sites. Conclusion The combined flap pedicled with the 2nd or 4th dorsal meta- carpal arteries could repair effectively the small skin and tendon defects in dorsum of finger ; free flap from dot- stun of foot could repair the large complex tissue defect of fingers ; the advantages of usage of composite flaps in the combined dorsal finger defects were to minimize the trauma and to shorten the treatment course with good fimctional recover.