腹部双叶轴型皮瓣同时修复手掌手背创面的疗效分析

Therapeutic Effect Analysis of Using Abdominal Bilobed Axial Pattern Flap to Repair Simultaneously Both Hand Palm and Dorsal Wounds

目的探讨腹部双叶轴型皮瓣同时修复手掌手背创面的方法和疗效。方法对2008年6月～2011年6月人院的．采用分别以旋髂浅动脉、腹部浅动脉为轴心血管的腹部双叶带蒂皮瓣转移修复的11例手掌、手背创面皮肤软组织缺损患者的临床资料进行分析，总结手术方法及临床疗效。结果本组患者皮瓣均成活，皮瓣色泽、质地良好．其中3例皮瓣外形较臃肿者，于术后3～6个月行皮瓣修薄术后外形满意。供皮区切口I期愈合。出院后随访6，16个月，平均8个月（其中9例患者获随访，2例失访），术后6个月皮瓣深痛觉恢复，浅感觉与触觉有少许恢复，保护性感觉均恢复。根据中华医学会手外科学会上肢部分功能评定试用标准评定术后6个月手指总主动活动度（TAM），优7例，良1例，差1例。结论采用腹部双叶轴型皮瓣同时修复手掌手背创面，手术简便安全．供区损伤小，术后患肢功能、外观佳，是修复手掌手背创面的较好方法之一。

Objective To explore the method and therapeutic effect of abdominal bilobed axial pattern flap in the simultaneous reparation of hand palm and dorsal wounds. Methods An analysis was carried out on the clinical data of 11 cases of soft tissue defect wounds at hand palm and dorsum, admitted into the hospital between June 2008 and June 2011, treated with pedicled abdominal bilobed flap with superficial iliac circumflex artery and superficial epigastric artery as the ax- ial vessels. The surgical method and clinical therapeutic effect were summarized. Results All the flaps survived with good color and texture. The flaps of 3 patients appeared excessive in thickness and 3 -6 months later, flap attenuation was per- formed on them resulting in satisfying appearance. The incision wounds of the donor sites realized phase I healing. After dis- charge, the patients were followed up for 6 - 16 months, averagely 8 months （among which, 9 successful follow-up, 2 loss to follow-up）. Six months after the operation, the deep pain sense of flaps restored completely while the superficial pain sense and touch sensation restored a little, and protective sensations all restored. According to the upper extremity functional evaluation standard set up by hand surgery branch of Chinese Medical Association, the total active motion （TAM） of fingers 6 months post-operation showed excellent in seven patients, good in one and bad in one. Conclusion Applying abdominalbilobed axial pattern flap in the simultaneous reparation of hand palm and dorsal wounds is safe and easy-to-operate, causes less donor site injury and can realize good function and appearance of the affected limbs. Thus, abdominal bilobed axial pat- tern flap is one of the effective therapies for the reparation of hand palm and dorsal wounds.