逆行骨间后动脉双叶穿支皮瓣修复腕部皮肤软组织缺损疗效分析

Repair of skin and soft tissue defects on the wrist with reverse bi-pedicle posterior interosseous artery perforator flap

目的 探讨逆行骨间后动脉双叶穿支皮瓣修复腕部皮肤软组织缺损的疗效 方法 2010年12 月-2012年3月,笔者单位收治7例腕部皮肤软组织缺损的患者,其中单纯皮肤软组织缺损4例、皮肤软组织缺损合并桡侧肌腱缺损3例,腕掌侧皮肤缺损面积为4.8 cm ×4.0 cm～6.2 cm×4.5 cm,腕背侧皮肤缺损面积为3.5 cm×3.2c m～6.5 cm ×5.4 cm 腕部创面缺损原因：交通伤3例、机器绞伤2例、烧伤1例、肿瘤切除术后1例 采用逆行骨间后动脉双叶穿支皮瓣修复创面,一叶皮瓣大小为2.5cm ×2.0 cm～3.5cm×2.5 cm,另一叶皮瓣大小为2.5cm×2.5cm～4.0cm×3.0cm,皮瓣供 区直接拉拢缝合 . 结果 术后皮瓣均完全成活 随访6～36个月,患者皮瓣色泽、质地、外形良好,末次随访时皮瓣两点辨别觉距离为9～ 13 mm,腕关节背伸、掌屈功能恢复较佳,根据中华医学会手外科学会上肢部分功能评定试用标准,患者腕部功能评定结果为优6例、良1例. 供区遗留一线形瘢痕 . 结论 逆行骨间后动脉双叶穿支皮瓣修复腕部皮肤软组织缺损具有设计灵活、切取方便、供区损伤小、血供可靠等优点,是修复该类创面的义一选择.

Objective To explore the curative effect of reverse bi-pedicle posterior interosseous artery perforator flap in repairing skin and soft tissue defects on the wrist.Methods Seven patients with soft tissue defects on the wrist,including simple skin and sott tissue defects in 4 cases and skin and soft tissue defects combined with radial tendon injury in 3 cases,were hospitalized from December 2010 to March2012.The areaofskin defect on the volar sideofthe wrist ranged from 4.8 cm×4.0 cm to6.2 cm ×4.5 cm,while that on the dorsal side ranged from 3.5 cm × 3.2 cm to 6.5 cm × 5.4 cm.These wounds were respectively caused by traffic injury （3 cases）,reamer injury （2 cases）,burn （1 case）,and tumor resection （1 case）.Reverse bi-pedicle posterior interosseous artery perforator flaps were used to repair these defects,with area of one pedicle ranging from 2.5 cm × 2.0 cm to 3.5 cm × 2.5 cm and the area of the other pedicle ranging from 2.5 cm × 2.5 cm to 4.0 cm × 3.0 cm.The donor sites were closed by suturing.Results All flaps survived completely.Patients were followed up for 6 to 36 months.The color,texture,and appearance of all flaps were satisfactory.At last follow-up,distances of two-point discrimination of flaps ranged from 9 to 13 mm.The dorsal extension and palmar flexion functions of wrist were satisfactory.The resuhs of function evaluation of 7 wrists were excellent in 6 cases and good in 1 case according to the tentative standards for the evaluation of upper extremity function of Society of Hand Surgery of Chinese Medical Association.A linear scar was formed at the donor site.Conclusions The reverse bi-pedicle posterior interosseous artery perforator flap,with advantages of flexible design,easy to achieve,less injury to donor site,and reliable blood supply,etc.,is another choice for repairing skin and soft tissue defects over the wrist.