桡动脉鼻烟窝穿支皮瓣与手指侧方顺行岛状皮瓣瓦合修复拇指旋转撕脱离断后大面积套状皮肤缺损

Snuffbox radial artery perforator flap combined with lateral finger island flap for repairing large skin defects after thumb rotation avulsion injury

目的 探讨应用桡动脉鼻烟窝穿支皮瓣与手指侧方顺行岛状皮瓣瓦合修复拇指旋转撕脱离断后大面积套状皮肤缺损的临床疗效.方法 2010年6月至2013年5月,应用桡动脉鼻烟窝穿支皮瓣与手指侧方顺行岛状皮瓣瓦合修复拇指旋转撕脱离断后大面积套状皮肤缺损10例,皮肤缺损面积6.0 cm× 3.0 cm～10.0 cm× 8.0 cm,根据桡动脉鼻烟窝穿支及手指指固有神经血管解剖特点,于前臂远端及手指侧方设计皮瓣,皮瓣内含桡动脉鼻烟窝穿支、桡神经浅支及指固有神经血管.结果 所有皮瓣和移植皮片全部存活.随访6个月至2年,20块皮瓣感觉恢复情况：2块S1,4块S2,8块S3,6块S4.桡动脉鼻烟窝穿支皮瓣静态两点分辨觉为5～ 10 mm,手指侧方顺行岛状皮瓣静态两点分辨觉为3～8mm,皮瓣质地柔软、耐磨,手部功能及外形恢复较好,拇指指腹感觉功能恢复良好.按照中华医学会手外科学会手指再造功能评定试用标准综合评价：修复手指功能优7例,良2例,可1例;优良率90.0％.结论 桡动脉鼻烟窝穿支皮瓣与手指侧方顺行岛状皮瓣血供安全、可靠,是修复拇指旋转撕脱离断后大面积套状皮肤缺损的理想皮瓣,不需吻合血管,皮瓣感觉恢复良好,是一种简单实用的手术方法.

Objective To investigate the clinical outcomes of applying snuffbox radial artery perforator flap combined with lateral finger island flap to repair a large area of skin defect after thumb rotation avulsion injury.Methods From June 2010 to May 2013,10 cases with skin defects following thumb rotation avulsion injury were treated with this combined flap.The size of the defects ranged from 6.0 cm × 3.0 cm to 10.0 cm × 8.0 cm.Based on the anatomy of the radial artery snuffbox perforator and the proper digital neurovascular bundle,the combined flaps were designed at the distal forearm and lateral aspect of the finger to include the radial artery snuffbox perforator,superficial radial nerve and the proper digital neurovascular bundle.Results All the flaps and skin grafts survived.All the cases were follow-up for 6 to 24 months.Sensory recovery of the skin flap reached S1 in 2 cases,S2 in 4 cases,S3 in 8 cases,and S4 in 6 cases.Two-point discrimination was 5 to 10 mm on the snuffbox radial artery perforator flaps,and 3 to 8 mm on the lateral finger island flaps.The color,texture and contour of the flaps were good.According to the functional evaluation criteria of the Hand Surgery Society of Chinese Medical Association,the reconstruction results were rated as excellent in 7 cases,good in 2 cases,fair in 1 case,with a satisfactory rate of 90.0%.Conclusion A snuffbox radial artery perforator flap combined with lateral finger island flap is ideal for repairing large skin defects resulted from thumb rotation avulsion injury.The flaps have reliable blood supply without the need to anastomose blood vessels,as well as sensory nerves that restore good flap sensation.The procedure is safe and simple.