游离大鱼际穿支皮瓣修复指腹软组织缺损

Free thenar perforator flap to repair soft tissue defect of the pulp

目的探讨应用游离大鱼际皮瓣修复指腹软组织缺损的方法和临床效果。方法对2009年9月至2011年1月收治的13例指腹软组织缺损，应用游离大鱼际皮瓣修复。以桡动脉掌浅支及其构成的血管网为血管蒂重建供血，以正中神经掌皮支或桡神经浅支重建皮瓣感觉。皮瓣切取面积为4．7cm×3．0cm～2．0cm×2．0cm。结果术后2例皮瓣出现血管危象，经对症处理后存活；余11例皮瓣顺利存活。13例均获得随访，时间为3～12个月，平均4个月。仅1例皮瓣略显臃肿，经再次整形后臃肿消失；其余皮瓣外观及弹性良好，感觉恢复至S3～S4。结论以桡动脉掌浅支及其构成的血管网为血管蒂的大鱼际皮瓣，其血管解剖表浅、皮肤穿支丰富、感觉重建满意，是修复指腹中小面积缺损的有效方法。

Objective To introduce the surgical technique of applying free thenar perforator flap to repair soft tissue defects of the pulp and evaluate the clinical outcome. Methods From September 2009 to January 2011, 13 cases of soft tissue defect of the pulp were treated with free thenar perforator flap. The size of the harvested flaps was between 4.7 cm×3.0 cm to 2.0 cm × 2.0 cm. The flap was perfused by superficial palmar branch of the radial artery and its vascular network, while sensation of the flap was reconstructed via median nerve cutaneous branch or radial nerve superficial branch. According to caliber of the artery, blood vessels were anastomosed either in an end-to-end or end-to-side fashion. Results Vascular crisis occurred in 2 cases postoperatively, which were rescued by proper treatment. The other 11 transferred free flaps survived uneventfully. All cases were follow-up for 3 to 12 months. The appearance as well as texture of the flaps was satisfactory, except in one case the flap was bulky that required secondary debulking surgery. Sensation of the pulps recovered to S3 to S4. Conclusion The thenar flap based on superficial palmar branch of the radial artery and its vascular network is a good option to repair soft tissue defects of the pulp. It has superficial vascular pedicle which is easy to dissect, has abundant perforators, and has sensory nerve branched for sensory reconstruction.