掌背动脉逆行复合组织瓣修复手指复杂损伤

Reversed flap based on dorsal metacarpal artery in repairing finger complex injury

目的 探讨掌背动脉复合组织瓣在手指皮肤软组织损伤并血管、神经、肌腱缺损治疗中的临床疗效。方法 根据掌背动脉的血供解剖学特点,设计以第2、3、4掌背动脉为供血的逆行岛状掌背动脉复合组织瓣,携带皮下浅静脉桥接指固有动脉缺损、掌背神经桥接指固有神经缺损、示小指固有伸肌腱修复关节囊或肌腱缺损、掌骨骨（膜）瓣修复指骨缺损。结果 19例中18例皮瓣全部成活,1例术后第1天肿胀,静脉回流不畅,拆除缝合线,远端约1 cm表皮坏死,经换药后愈合。随访3-18个月,平均9个月,温度觉、深感觉良好,皮瓣两点分辨率为4-10 mm。修复伸肌腱者无需二次松解,患指外形及功能满意,供区外形及功能正常。按皮瓣功能7项检查指标进行评定：优9例,良7例,可2例,差1例,优良率84.2%。结论 掌背动脉逆行复合组织瓣是修复杂手指缺损较为理想的方法,具有解剖简单、一期完成手术、血管变异率低等优点,宜推广应用。

Objective To investigate the clinical effect of the dorsal metacarpal artery compound flap in the finger soft tissueinjury or vessel, nerve, endon defection. Methods According to the dorsal metacarpal artery blood supply 2, 3, 4 dorsalmetacarpal artery flap was designed. The compound flap can be transported with subcutaneous vein, nerve, tendon and bone,which can repair homologous tissues. Results Among the 19 cases, 18 cases survived, one patient had swelling, because ofvein poor return, after taking out part of stitches the flap survived with 1 cm distal epidermal necrosis. Follow up was 3 to 18months, average 9 months. Temporature sensation, deep feeling good, the two-point respectively rate was 4 to 10 ram. Theextensor tendon did not requiresecond releasing, the appearance and function of finger and donor area were satisfactory.Theflap was evaluated by 7 indexes, excellent 9 cases, good in 7 cases, fair in 2 cases, poor in 1 case, the excellent and good ratewas 84.2%. Conclusion The reversed compound flap based on dorsal metacarpal artery repairing of finger complex defectionis an ideal method, with explicit anatomy, one-stage operation and low rate of vascular variation.