游离移植吻合皮神经的前臂双动脉化静脉皮瓣修复手指缺损疗效观察

EFFECTIVENESS OF FREE ANASTOMOSIS CUTANEOUS NERVE DOUBLE ARTERIALIZED VENOUS FLAP GRAFT FOR REPAIRING FINGER DEFECT

目的探讨游离移植吻合皮神经的前臂双动脉化静脉皮瓣修复手指缺损的临床疗效。方法 2010年5月-2013年5月,收治39例手指缺损患者。男27例,女12例;年龄17~45岁,平均31岁。受伤至入院时间30~90 min,平均60 min。致伤原因:机械伤23例,挤压伤11例,其他5例。拇指13例,示指11例,中指9例,环指4例,小指2例。皮肤软组织缺损范围2 cm×1 cm^4 cm×2 cm。其中22例伴单纯肌腱损伤,17例伴肌腱及指骨损伤。采用大小为2.5 cm×1.5 cm^4.5 cm×2.5 cm的吻合皮神经的前臂双动脉化静脉皮瓣游离移植修复缺损。前臂供区直接缝合。结果 5例术后3~5 d皮瓣远端出现张力性水疱及肿胀,对症处理后成活;其余34例顺利成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合。患者均获随访,随访时间6~12个月,平均9个月。皮瓣外观质地良好,皮瓣两点辨别觉6~9 mm,平均7.5 mm。末次随访时,按中华医学会手外科学会上肢部分功能评定试用标准评价手指功能,获优35例,良4例。结论采用吻合皮神经的前臂双动脉化静脉皮瓣游离移植修复手指缺损,既保证了皮瓣血供,又明显改善了皮瓣感觉,大大降低术后皮瓣萎缩风险,术后疗效满意。

Objective To explore the effectiveness of the free anastomosis cutaneous nerve double arterialized venous flap graft in repairing finger defect. Methods Between May 2010 and May 2013, 39 patients with finger defect were treated. There were 27 males and 12 females with an average age of 31 years （range, 17-45 years）. The injury to admission time was 30- 90 minutes （mean, 60 minutes）. The causes included mechanical injury in 23 cases, crush injury in 11 cases, and other injury in 5 cases. The thumb was involved in 13 cases, the index finger in 11 cases, the middle finger in 9 cases, the ring finger in 4 cases, and the little finger in 2 cases. Skin soft tissue defect ranged from 2 cm x 1 cm to 4 cm x 2 cm. Of them, 22 cases had tendon injury, 17 cases had tendon and phalanx injuries. The size of free anastomosis cutaneous nerve double arterialized venous flap ranged from 2.5 cm x 1.5 cm to 4.5 cm x 2.5 cm. The donor site was directly sutured. Results Tension blister and swelling were observed at distal flap in 5 cases at 3-5 days after operation and were cured after symptomatic treatment; the other 34 flaps survived, and wound healed by first intention. Primary healing at donor site was obtained. The patients were followed up 6-12 months （mean, 9 months）. The flap appearance and texture were good with two-point discrimination of 6-9 mm （mean, 7.5 mm）. According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of Chinese Medical Association, the results were excellent in 35 cases and good in 4 cases. Conclusion The free anastomosis cutaneous nerve double arterialized venous flap not only can ensure the flap blood supply, but also can obviously improve the sensory function of the flap, which greatly reduces the risk of postoperative flap atrophy, and can achieved satisfactory effectiveness.