短节段指动脉蒂改良逆行指动脉皮瓣的临床研究

The clinical study of modified retrograde finger arterial flaps in short segment

目的探讨以手指中节指动脉为血管蒂的改良逆行指动脉皮瓣修复手指指端缺损的手术方法和临床疗效。方法将传统的逆行指动脉皮瓣做进一步改良,与指动脉背侧支皮瓣理念相结合,设计短节段指动脉蒂的改良逆行指动脉岛状皮瓣。2016年1月-2017年9月对11例指端缺损病例应用该皮瓣行创面修复。结果 11例皮瓣全部Ⅰ期成活,其中1例皮瓣在切取后,边缘出血不活跃,将皮瓣修复创面后第2天皮瓣渐红润。1例皮瓣术后淡紫,水疱形成,未特殊处理,4 d后皮瓣色转淡红。结论本皮瓣设计将指动脉在近节指横纹处切断为旋转蒂,通过指动脉在手指中节基底部发出的皮支经指侧皮支链对皮瓣供血,对指动脉损伤小,既有指动脉岛状皮瓣供血可靠,又有指动脉背侧穿支皮瓣对指体供血的保护的优点,皮瓣蒂部携带的无效筋膜组织量少、血管蒂部旋转更灵活,符合临床要求。

Objective To explore the operation method and clinical efficacy of the modified retrograde finger arterial flap which was based on the vascular pedicle of middle segment digital artery to repair fingertip defect.Methods The short segment retrograde finger arterial flap derived from traditional retrograde finger arterial flap and combined digital arterial dorsal branch island flap.From January 2016 to September 2017,11 cases of fingertip detect were repaired with the modified short segment flaps.Results All 11 cases were primary survival.One case was short of blood supply at flap edge after surgery,and turned red next day.One flap had pale purple colour and blister formation,and turned red four days later without any special treatment.Conclusion The modified flap pedicled with dorsal branch of middle segment digital artery which is cut off in horizontal lines of PIP joint.It is meeting clinical requirements as a tiny finger arterial injury,less nonfunctioning fibrous tissues,and more flexible vascular pedicle rotation.And all the advantages of modified flap result from reliable blood supply of traditional retrograde finger arterial flap,and great finger blood supply protection from digital arterial dorsal branch island flap.