逆行前臂外侧皮神经营养血管筋膜蒂皮瓣修复手部皮肤缺损

EFFECTIVENESS OF RETROGRADE ISLAND NEUROCUTANEOUS FLAP PEDICLED WITH LATERAL ANTEBRACHIAL CUTANEOUS NERVE IN TREATMENT OF HAND DEFECT

目的探讨逆行前臂外侧皮神经营养血管筋膜蒂皮瓣修复手部皮肤软组织缺损的疗效。方法 2011年10月-2013年12月,收治17例手部皮肤软组织缺损患者。男8例,女9例;年龄23~62岁,平均44岁。外伤13例,伤后至手术时间2~6 h,平均3.5 h;脱套伤术后创面2例;外伤后虎口挛缩切除术后2例。缺损部位:手背侧5例,手掌桡侧4例,虎口2例,拇指掌侧4例,拇指桡背侧2例。15例伴骨、肌腱等深部组织外露。创面范围为3 cm×3 cm^12 cm×8 cm。采用大小为3.6 cm×3.6 cm^13.2 cm×8.8 cm的逆行前臂外侧皮神经营养血管筋膜蒂皮瓣修复创面,9例前臂外侧皮神经与受区皮神经吻合。供区直接拉拢缝合或植皮修复。结果术后2例皮瓣远端部分坏死,经换药后1个月愈合;其余皮瓣及植皮均顺利成活,创面Ⅰ期愈合。术后17例均获随访,随访时间5~30个月,平均12个月。皮瓣质地良好,外观满意。末次随访时,皮瓣感觉恢复达S2~S3+;其中9例吻合皮神经皮瓣感觉达S3~S3+,优于8例未吻合皮神经皮瓣的S2~S3。2例近指间关节伸直受限。末次随访时根据中华医学会手外科学会功能评定标准,获优15例,良2例。结论逆行前臂外侧皮神经营养血管筋膜蒂皮瓣血供可靠、操作简便,是修复手部皮肤软组织缺损的有效方法之一。

Objective To explore the effectiveness of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve in the treatment of soft tissue defect of the hand.Methods Between October 2011 and December 2013,17 cases of skin and soft tissue defects of the hands were treated.There were 8 males and 9 females,aged 23-62 years（mean,44 years）.Of them,defect was caused by trauma in 13 cases,by postoperative wound after degloving injury in2 cases,and by resection of contracture of the first web in 2 cases;13 cases of traumas had a disease duration of 2-6 hours（mean,3.5 hours）.The defect sites located at the back of the hand in 5 cases,at the radial side of the palm in 4 cases,at the first web in2 cases,at the palmar side of the thumb in 4 cases,and at the radial dorsal side of the thumb in 2 cases.The bone,tendons,and other deep tissue were exposed in 15 cases.The defect size varied from 3 cm x 3 cm to 12 cm x 8 cm.The size of the flaps ranged from 3.6 cm x 3.6 cm to 13.2 cm x 8.8 cm.The lateral cutaneous nerve of the forearm was anastomosed with the cutaneous nerve of the recipient sites in 9 cases.The donor sites were repaired by free skin graft or were sutured directly.Results The other flaps survived,and obtained healing by first intention except 2 flaps which had partial necrosis with healing by second intention at 1 month after dressing change.The skin graft at donor site survived,and incisions healed by first intention.All patients were followed up 5-30 months（mean,12 months）.The flaps had good color and texture.Flap sensory recovery of S_2-S_3-＋ was obtained;in 9 cases undergoing cutaneous nerve flap anastomosis,the sensation of the flaps recovered to S_3-S_3-＋ and was better than that of8 cases that the nerves were disconnected（S_2-S_3）.The patients achieved satisfactory recovery of hand function.Only 2 cases had extended limitation of the proximal interphalangeal joint.At last follow-up,according to the Chinese Medical Society of Hand Surgery function evaluation standards,the results were excellent in 15 cases and good in 2 cases.Conclusion Retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve is an effective way to repair skin defects of the hand,with the advantages of reliable blood supply and simple surgical procedure.