第一跖背（底）动脉蒂双叶皮瓣联合人工真皮修复相邻两手指中末节缺损

The free twin-flap with the first metatarsal dorsal（bottom） artery repair the defects of distal in adjacent two fingers

目的 探讨第1跖背（底）动脉蒂双叶皮瓣修复相邻两手指中末节缺损的临床应用效果. 方法 自2010年11月至2013年6月,应用第1跖背（底）动脉蒂（母）趾腓侧皮瓣和第2趾胫侧皮瓣联合移植修复相邻两手指中末节缺损9例,为解决动脉跨度不足及皮瓣供区骨和（或）肌腱外露、植皮不易成活的缺陷,将血管分叉处裸露的血管蒂部及足部供区用人工真皮覆盖,3周后切断皮桥,足部供区拆除人工真皮薄膜再切取自体中厚皮片植皮修复. 结果 术后9例18块皮瓣及供区植皮全部成活.随访4～12个月,修复效果满意,皮瓣色泽、质地与受区近似,皮瓣两点辨别觉8 ～12 mm,手指关节功能恢复良好,供区植皮外观饱满,无破溃、疼痛及瘢痕增生形成. 结论 第1跖背（底）动脉蒂双叶皮瓣联合人工真皮修复相邻两手指中末节缺损伤,解决了蒂部跨度不足、不能同时修复中末节缺损的缺陷,降低了手术难度及风险,同时足部供区处理简单、提高了足部供区植皮的成活率,治疗效果满意.

Objective To explore the clinical effect that the free twin-flap with the first dorsal （bottom） metatarsa artery repair the defects of distal in adjacent two fingers.Methods The twin-flap from the big toe and the second toe based on a single vascular pedicle of the firstl dorsal （bottom） metatarsa artery was designed in this article.From November 2010 to June 2013,this twin-flap was transferred in 9 patients.In order to solve the problems：the shortage of arterial span,the bone and （or）tendon exposed in the donor site,the thickness skin graft resurfaced in the donor site was not easy to survive,the bare vascular pedicle and the donor site were covered with artificial dermis for 3 weeks.After 3 weeks,cutting skin bridge and removing the thin of artificial dermis,the donor site was resurfaced by thickness skin graft.Results All cases were followed up for 4 to 12 months.All transfering flaps and the thickness skin graft were survival.The colours and texture of the flaps matched the recipient site.2-point discrimination ranged from 8 to 12 mm.Finger flexion and extension was satisfactory.The appearance of the donor site was well-stacked.No case had successive ulces,pain and car.Conclusion The twin-flap from the big toe and the second toe based on a single vascular pedicle of the first dorsal （bottom） metatarsal artery combined with artificial dermis to repair the defects of distal in adjacent two fingers.For one side,this operation can solve he shortage of arterial span and repair the defects of distal in adjacent two fingers at the same time.For another,it can provid a easy method for deal with the donor site and raise the survial rate of the thickness skin graft.Besides,it also is easy and safe,clinical effect is satisfaction.