游离腓动脉穿支腓肠神经营养血管皮瓣修复手背软组织缺损

Free Peroneal Artery Perforator Sural Neurocutaneous Flap for Repairing the Soft Tissue Defect of Back of the Hand

目的探讨游离腓动脉穿支腓肠神经营养血管皮瓣修复手背软组织缺损。方法通过对2012年3月—2013年3月在该院进行治疗的22例手背软组织缺损患者给予游离腓动脉穿支腓肠神经营养血管皮瓣修复术,观察患者的治疗效果。结果患者的临床治疗总有效率为86.4%。其中,痊愈9例,比例为40.9%;显效7例,比例为31.9%;有效3例,比例为13.6%;无效3例,比例为10.6%。术后所有皮瓣均完全成活,创面均为Ⅰ期愈合,术后6-14 d,1例患者出现远端表皮坏死,经及时换药治疗后愈合,1例患者出现远端表浅坏死,经修复愈合。术后8-20 d出现皮瓣远端坏死患者4例,1例患者经植皮修复愈合,1例患者二期缝合愈合,1例患者出现感染,创面未愈合,皮瓣移位修复后愈合,供区的植皮全部成活。随访时间为6-18个月,平均随访时间为（12.8±0.7）月。术后均无明显肿胀和淤血,肌腱损伤患者未出现粘连,骨折患者愈合良好。结论游离腓动脉穿支腓肠神经营养血管皮瓣的质地优良,操作简便,恢复效果好,外形美观,供血可靠,为修复手背软组织缺损的首选方法之一,临床值得推广应用。

Objective To investigate the effect of free peroneal artery perforator sural neurovascular flap on repairing the soft tissue defect of back of the hand. Methods 22 cases with soft tissue defects of back of the hand treated in our hospital from March,2012 to March, 2013 were given the free peroneal artery perforator sural neurovascular flap repair. The treatment effect of the patients was observed. Results The clinical total effective rate of the patients was 86.4%. Among them, 9 cases were cured, accounted for 40.9%; 7 cases were markedly effective, accounted for 31.9%; 3 cases were effective, accounted for 13.6%; 3 cases were ineffective, accounted for 10.6%. All flaps survived completely after the operation. All the wound were healed by first intention.6d-14d after the operation, 1 case had distal skin necrosis and was healed after timely dressing treatment, 1 case had distal superficial necrosis, and was healed by repairing. 8d-20d after the operation, 4 cases had distal skin flap necrosis, of them, 1 case was healed by skin grafting, 1 case was healed by secondary suture, 1 case＇s wound was not healed due to infection, but healed after transplanted skin flap repairing, and all the skin grafts in the donor site survived. The follow-up time was 6-18months, with the average follow-up time（12.8 ± 0.7） months. There was no significant swelling and bruising after surgery, patients with tendon injuries did not have adhesions and patients with fractures were healed excellently. Conclusion The free peroneal artery perforator sural neurovascular flap has fine texture, is easy to operate with good recovery effect, nice appearance and reliable blood supply, it is one of the preferred methods for repairing soft tissue defects of the back of the hand and worthy of clinical application.