不同血管来源的小鱼际穿支皮瓣游离移植修复手指指腹皮肤缺损

The clinical results of free hypothenar perforator flap based on different sources of blood vessels transfer in the treatment of skin defects of the finger

目的探讨应用不同血管来源的小鱼际穿支皮瓣游离移植修复指腹皮肤缺损的临床效果。方法回顾性分析宁波市第六医院手外科2014年4月至2016年9月采用不同血管来源的小鱼际穿支皮瓣游离移植修复的15例指腹皮肤缺损患者资料,男10例、女5例,年龄18~62岁。所有病例均合并神经、血管、肌腱或骨外露,缺损面积为1.5 cm×3.5 cm^2.0 cm×4.5 cm。应用血管来源于尺动脉深支近端的小鱼际皮瓣修复5例,血管来源于小指尺掌侧指动脉分支的小鱼际皮瓣修复8例,血管来源于掌浅弓分支的小鱼际皮瓣修复2例,供区皮肤直接缝合。结果术后3例皮瓣出现血管危象,经对症处理后成活;余12例皮瓣顺利成活。所有患者术后获3~24个月随访,平均13.5个月。皮瓣全部成活,质地色泽优良,不臃肿,患指功能恢复良好,感觉恢复S3,两点辨距觉8~9 mm,供区创面仅留线性瘢痕。结论不同血管来源的小鱼际穿支皮瓣游离移植修复指腹皮肤缺损,皮瓣切取相对容易,血管解剖恒定,供区损伤较小,受区外观、质地和功能恢复良好,可供作为修复小面积指腹皮肤缺损的方案之一。

Objective To evaluate the outcome of free hypothenar perforator flap, with different vascular perforators, in fingerskin defects repairment. Methods From April 2014 to September 2016, 15 cases of skin defects on finger were treated with hypothenar perforator flap, based on different vascular perforators.Patients had nerves, vessels, tendons or bone exposure.Defects ranged from 1.5 cm×3.5 cm to 2.0 cm×4.5 cm in size. Fivecases were treated with hypothenar perforator flap based on a cutaneous perforator branch of the ulnar artery, 8 cases were based on acutaneous perforator branch of the ulnar digital artery, 2 cases were based on branch of the superficial volar arch.Donor site was closed directly. Results Vascular crisis occurred in 3 cases postoperatively, which were rescued by propertreatment. Other 12 transferred free flaps survived uneventfully.After averaged 13.5-month postoperative follow-up (ranging from 3 to 24 months), the appearance of transferred flaps was satisfactory. Flap texture was good with no obvious atrophy. All the fingers had good function.The sensation of flaps recovered to S3, and two-point discrimination was 8-9 mm. The donor site was healed with linear scar. Conclusions The hypothenar perforator free flap was relatively easy to practice.Constant vascular anatomy, the appearance, texture and good functional recovery after hypothenar free flap transferring, suggest this is achoice for repairing small skin defects on finger.