改良游离尺动脉腕上皮支下行支皮瓣移植修复手指软组织缺损

Modified free flap based on the descending branch of ulnar artery above-wrist cutaneous branch for coverage of soft tissue defect of the finger

目的探讨改良法切取尺动脉腕上皮支下行支皮瓣修复手部软组织缺损的可行性及疗效。方法2008年11月至2011年11月，切取尺动脉腕上皮支下行支皮瓣修复手指软组织缺损30例30指，改良方法为利用尺动脉腕上皮支的走行准确定位皮瓣的设计，同时切取部分尺动脉作为皮瓣供血动脉进行吻合，皮瓣切取面积为2．0cm×4．0cm～4．5cm×7．0cm。结果除1例皮瓣部分坏死经换药植皮外，其余29例皮瓣均顺利存活，2例术后行皮瓣整形术。所有患者随访6～24个月，按中华医学会手外科学会手部功能评定标准评定：优27例，良2例，可1例；优良率为96．6％。皮瓣两点分辨觉为8-12mm。结论游离尺动脉腕上皮支下行支皮瓣是修复手指软组织缺损的良好术式，改良法提高了手术的安全性，有利于临床推广。

Objective To investigate the feasibility of a modified technique of harvesting the flap based on the descending branch of ulnar artery above-wrist cutaneous branch and evaluate its clinical results in repairing soft tissue defect of the fingers. Methods From November 2008 to November 2011, 30 patients with soft tissue defect of the fingers were treated with the above mentioned flap. The modified method was to design the flap based on the precise projection of ulnar artery above-wrist cutaneous branch. Part of the ulnar artery was also included in the vascular pedicle for blood vessel anastomosis. The area of the flaps ranged from 2.0 cmx 4 cm to d. 5 cm ~ 7.0 cm. Results Complete survival was achieved in 29 flaps uneventfully. Distal necrosis occurred in 1 flap, which was managed by debridement and skin graft. Secondary flap plasty was done in 2 cases. Postoperative follow-up period ranged from 6 to 24 months. The outcomes were graded as excellent in 27 cases, good in 2 cases, fair in 1 case according to the functional assessment criteria for upper extremities issued by the Hand Society of the Chinese Medical Association, achieving a 96.6% good and excellent rate. Two-point discrimination of the flaps was 8 to 12 mm. Conclusion The flap based on the descending branch of ulnar artery above-wrist cutaneous branch can be used satisfactorily to repair soft tissue defect of the finger. The modified method can effectively improve the safety of the procedure, which is beneficial to the promotion of use of the flap.