大鱼际穿支皮瓣与拇指尺背侧筋膜皮瓣瓦合修复拇指桡侧半环形软组织缺损

Thenar perforator flap combined with thumb dorsouinar flap for repair of radial semicircular soft tissue defects of thumb

目的 探讨大鱼际穿支皮瓣与拇指尺背侧筋膜皮瓣瓦合修复拇指桡侧半环形软组织缺损的方法及临床效果。方法 自2013年3月至2016年9月,我们利用大鱼际穿支皮瓣与拇指尺背侧筋膜皮瓣瓦合修复8例拇指桡侧半环形软组织缺损患者,大鱼际穿支皮瓣切取面积为3.5cm×2.0cm^2.5cm×1.5cm,修复掌侧创面;拇指尺背侧筋膜皮瓣切取面积为3.0cm×2.0cm^2.5cm×1.5cm,修复背侧创面,供区取全厚皮片植皮修复。结果 术后8例皮瓣全部存活,随访时间为6-12个月,平均9个月,皮瓣外形及质地满意,大鱼际穿支皮瓣感觉恢复至S3~S3+,两点分辨觉恢复至7-9mm;拇指尺背侧筋膜皮瓣感觉恢复至S2-S3,两点分辨觉恢复至8~11mm。供区外形及功能无明显影响。结论 大鱼际穿支皮瓣与拇指尺背侧筋膜皮瓣瓦合修复拇指桡侧半环形软组织缺损,手术操作简单,不损伤主要血管,术后疗效满意。

Objective To investigate the method and clinical efficacy of thenar perforator flap combined with thumb dorsoulnar flap in the treatment of radial semicircular soft tissue defects of thumb. Methods From March2013to September2016,8cases of radial semicircular soft tissue defects of thumb were treated by thenar perforator flap combined with thumb dorsoulnar flap.The area of thenar perforator flaps ranged from3.5cm×2.0cm to2.5cm×1.5cm for covering volar thumb defects.The area of thumb dorsoulnar flaps ranged from3.0cm×2.0cm to2.5cm×1.5cm for covering dorsal thumb defects.The donor sites were closed by full thickness skin graft.Results All 8cases of skin flaps survived.Postoperative follow-up ranged from6to12months with an average of9months.The appearance,texture and color of the flaps were satisfactory.The sensation of thenar perforator flap recovered from S3 to S3+,and the two-point discrimination recovered from7to9mm.The sensation of thumb dorsoulnar flap recovered from S2toS3, and the two-point discrimination recovered from8to11mm.There is no obvious effect on the shape and function of the donor sites.Conclusion It is a simple surgical method to repair radial semicircular soft tissue defects of thumb using thenar perforator flap combined with thumb dorsoulnar flap without damaging main vessels,which has satisfactory clinical efficacy.