小指尺掌侧动脉穿支皮瓣的临床应用

Clinical application of little finger ulnar palmar artery perforator flaps

目的 探讨应用小指尺掌侧动脉穿支皮瓣修复手背、小指皮肤缺损的可行性.方法 根据术式解剖学基础,在手背尺侧设计并切取小指尺掌侧动脉穿支皮瓣移位修复手背、小指创面15例.致伤原因：冲床冲压伤5例,电刨伤4例,机器压砸伤3例,爆炸伤2例,电烧伤后瘢痕挛缩1例.损伤部位：小指近中节掌侧皮肤缺损4例,小指近中节背侧皮肤缺损6例,手背中远段尺侧皮肤缺损3例,手掌尺侧远端皮肤缺损2例;左手6例,右手9例.结果 15例小指尺掌侧动脉穿支皮瓣全部成活,创面Ⅰ期愈合.经过2～18个月随访,皮瓣色泽红润,质地优良,患者对供、受区功能和外形满意.结论 小指尺掌侧动脉穿支皮瓣穿支血管较恒定,血供丰富,质地优良,手术操作简单、安全,是修复手掌及小指近节缺损创面理想的方法之一.

Objective To investigate the feasibility of repairing soft-tissue defects of the fifth phalange and the back of hand with ulnar palmar artery perforator flaps from the little finger.Methods Based on anatomic dissection,the fifth phalange ulnar palmar artery perforator flaps were created and transferred to repair soft-tissue defects at the little finger and the back of hand in 15 cases.Types of injury were stamping injury in 5 cases,planer injury in 4 cases,mechanical crash injury in 3 cases,blast injury in 2 cases,and cicatrical contracture following electric burn in 1 case.Injury involved in the palmar aspect near the middle segment of fifth phalange in 4 cases,dorsal aspect near the middle segment of fifth phalange in 6 cases,ulnar mesiodistal of the back of hand in 3 cases,and distal ulnar palmar aspect of hands in 2 cases.There were 6 patients wounded in left hands and 9 patients wounded in right hands.Results All flaps survived and all wounds healed by first intention.At the follow-up of 2-18 months,the flaps resurfaced the soft-tissue defects with good color and texture match and the maintenance of contour and function of donor and recipient sites were satisfactory.Conclusion The fifth phalange ulnar palmar artery perforator flap,as it has advantages of constant perforator vessels,rich blood supply and good texture and can be operated safely and easily,is considered an ideal treatment choice in repairing softtissue defects of the fifth phalange and the back of hand.