尺动脉近段穿支皮瓣移植修复手指皮肤缺损临床研究

Ulnar artery proximal perforator flap transfer for reconstruction of soft tissue defects of the fingers： aclinical observation

目的研究前臂近段尺动脉穿支皮瓣修复手指创面的临床应用，评价皮瓣的修复效果。方法2010年5月至2011年10月，对7例手指皮肤缺损的患者，以尺动脉肘下9．0cm处穿支点为中心，设计切取前臂近段尺动脉穿支皮瓣游离移植修复。分别于3、6、12个月随访，问卷调查患者对皮瓣满意度（％）及恢复正常工作的时间（d），检测皮瓣痛触觉、温度觉、两点分辨觉（mm），检测手指关节总活动度（TAM）及与健侧的比值，并进行上肢功能评定表（DASH）检测。结果6例皮瓣顺利存活；1例术后出现血管危象，行血管探查后存活。术后3个月，皮瓣较薄，具有较好的外形，患者满意度高（100％），平均恢复正常工作时间（27．20±5．70）d。术后6个月，皮瓣恢复痛温觉和轻触觉。术后12个月皮瓣两点分辨觉为6．30～9．70mm，平均（7．30±1．30）mm，皮瓣感觉为S＋。术后12个月，患侧TAM值与健侧的比值为（0．92±0．18），DASH值为（8．73±1．67）。结论前臂近段尺动脉穿支微型皮瓣是一种新型穿支皮瓣，其穿支点范围恒定、切取后对供区损伤小、术后恢复时间短、皮瓣有较好的外形和感觉恢复，是一种可应用的皮瓣选择。

Objective To investigate the clinical application of ulnar artery proximal perforator flap in the repair of skin and soft tissue defects of the fingers and report the aesthetic and functional results of the procedure. Methods From May 2010 to October 2011, 7 cases with skin and soft tissue defects of the fingers were treated with the flap. The ulnar artery proximal perforator flap was designed to center around the perforating point at 9.0 cm below the elbow. The free flap was harvested and transferred to cover the defects. At 3, 6 and 12 months postoperatively pain prick, touch and temperature sensation of the flaps were examined, as well as the two-point discrimination. Total active range of motion （TAM） of the finger joints and DASH function evaluation were performed. Questionnaire of patients＇ satisfaction of the flap aesthetics and the return-to-work time were collected. Results Six of the 7 flaps survived uneventfully. Vascular crisis occurred in 1 flap which was resolved by surgical exploration. The flaps were thin and had near normal appearance 3 months postoperatively. The patients were very satisfied（ 100% ） with flap aesthetics. The average return-to-work time was （27.20± 5.70） days. Pain, temperature and light touch sensation was restored 6 months after the surgery. Two-point discrimination was （7.30 ± 1.30） mm on average （range, 6.30 to 9.70 mm） for the flaps at 12 months postoperatively. Sensory recovery of the flaps was rated as S3＋ . TAM of the affected fingers was （0.92± 0.18） of the normal fingers. DASH function evaluation scored （8.73 ± I. 67）. Conclusion Ulnar artery proximal perforator mini-flap is a new perforator flap. It has constant perforating point and perfusiou area. Flap resection leads to little donor site damage. It results in good postoperative appearance, short function recovery time, and good sensory recovery. This flap is a good option for the repair of finger defects.