指固有动脉近侧穿支“旗状”皮瓣的临床应用

Clinical application of the area of "flag" flap on the proximal perforator digital artery

目的总结改良供区的"旗状"供血指固有动脉近侧穿支皮瓣修复手指远端组织缺损的临床疗效。方法 2009年9月至2012年9月,应用改良供区的"旗状"供区指固有动脉穿支皮瓣修复手指远端组织缺损29例32指。男18例,女11例;年龄12~68岁,平均42岁。左手13例14指,右手16例18指。食指12例,中指10例,环指4例,小指6例,均为中末节组织缺损。创面范围为0.8 cm×1.0 cm^1.8 cm×2.8 cm,病程1 h^2个月,术中皮瓣切取范围为1.0 cm×1.3 cm^2.0 cm×3.0 cm,供区全厚皮植皮修复。结果所有皮瓣及植皮均I期愈合。术后22例23指获随访,随访时间6~12月,平均8月。手指功能恢复良好,无感觉过敏,皮瓣色泽、质地良好,供区少许色素沉着,无明显功能障碍。据TAM评定标准:优:17指;良:3指;中:3指;差:0指。皮瓣感觉功能评定标准:S1—0例;S2—0例;S3—3例;S4—6例;S5—14例。两点辨别觉0.5~0.8 cm。结论改良供区的"旗状"供血指固有动脉穿支皮瓣修复手指远端组织缺损效果较好,该手术操作简便,血供可靠,供区隐蔽,术后供区手指功能无影响。

Objective To summarize the clinical efficacy proper artery blood supply in donor site for repairing distal to September, 2012, the application of modified donor site repairing the distal finger tissue defects in 29 cases with 32 of improving perforator flap with ＂ flag - like＂ distal finger tissue defect. Methods From September, 2009 ＂flag＂ on the proper digital artery perforator flap for fingers. Eighteen males and 11 females cases with a mean age of 42 years old ranged from 12 to 68 years old including the left hand in 13 cases with 14 fingers and the other 16 cases with 18 fingers were collected. All the cases were in the distal tissue defect, in which the in- dex finger in 12 cases, middle finger in 10 cases, ring finger in 4 cases and little finger in 6 cases were indica- ted. The defect size ranged from0.8 cm × 1.0 cmto 1.8 cm × 2.8 cm with the course of l hour to2 months and the size of the harvested flaps from 1.0 cm × 1.3 cm to 2.0 cm × 3.0 cm. The donor site was treated with thickness skin grafting. Results All the flaps and skin grafts survived uneventfully. After surgery, twenty - two cases of 23 refers were followed up for 6 months to 12 months with average time of 8 months. Finger function was recovered well with no hypersensitivity, good color and texture of the flap. Little pigmentation was shown in the flap donor site without obvious dysfunction. According to TAM evaluation standard, seventeen fingers were excel- lent, 3 fingers were good, 3 fingers were fair and no finger was poor in all the cases. According to flap sensory function assessment standards： S1 （0 case）, S2 （0 case）, S3 （3 cases）, S4 （6 cases）, S5 （14 cases）. The two - point discrimination was from 0.5 cm to 0.8 cm. Conclusion The efficacy of improving perforator flap with ＂flag -like＂ distal proper artery blood supply in repairing distal finger tissue defect is good with simple opera- tion, reliable blood supply, hidden donor site and no dysfunction in postoperative flap field.