游离隐血管皮瓣修复上肢皮肤软组织缺损

REPAIR OF UPPER LIMBS TISSUE DEFECT WITH DISSOCIATIVE SAPHENOUS ARTERIA FLAP

目的探讨游离隐血管皮瓣修复上肢皮肤软组织缺损的疗效。方法 2012年6月-2014年4月,收治10例上肢皮肤软组织缺损患者。男6例,女4例;年龄23~58岁,平均42岁。机器致伤9例,伤后至手术时间2 h^32 d,平均5.5 d;损伤部位:手背桡侧3例,前臂背侧6例。虎口挛缩切除术后皮肤缺损伴肌腱外露1例。皮肤软组织缺损范围为5 cm×3 cm^16 cm×9 cm。采用大小为6.0 cm×3.6 cm^19.2 cm×10.8 cm的游离隐血管皮瓣修复创面;7例皮瓣所携隐神经分别与受区皮神经、桡神经或尺神经吻合,5例复合部分缝匠肌肌腱行桥接移植修复肌腱缺损。供区直接拉拢缝合或植皮修复。结果术后1例皮瓣边缘部分坏死,经换药后1个月愈合;其余皮瓣及植皮均顺利成活。10例均获随访,随访时间5~17个月,平均12个月。皮瓣质地良好,外观满意。末次随访时皮瓣无挛缩,色泽与手部皮肤相近,无破溃,虎口无挛缩,皮瓣感觉恢复达S1~S3+;其中7例吻合皮神经皮瓣感觉优于未吻合神经皮瓣。5例行复合缝匠肌肌腱桥接移植修复者,手部肌腱功能恢复满意,末次随访时仅1例总主动活动度>健侧75%。根据中华医学会手外科学会上肢部分功能评定试用标准,获优8例,良2例。结论游离隐血管皮瓣血供可靠、手术操作简便,是修复上肢皮肤软组织缺损的有效方法之一。

Objective To explore the effectiveness of the dissociative saphenous arteria flap in repairing upper limbs soft tissue defect.Methods Between June 2012 and April 2014,10 cases of skin and soft tissue defects at the upper limbs were treated,including 6 males and 4 females with an average age of 42 years（range,23-58 years）.The causes of injury was the machine injury in 9 cases,the interval of injury and operation was 2 hours to 32 days（mean,5.5 days）;the locations were the dorsal radial side in 3 cases and the dorsal forearm in 6 cases.Skin defect with tendon exposure was observed in 1 case after contracture of the first web space resection.The defect size varied from 5 cm×3 cm to 16 cm×9 cm.The size of the flaps ranged from 6.0 cm×3.6 cm to 19.2 cm×10.8 cm.In 7 cases,the saphenous nerve was anastomosed with the nerve of the donor（cutaneous nerve,radial nerve,or ulnar nerve）;in 5 cases,tendon defect was repaired by sartorius muscle tendon bridge.The donor sites were repaired by free skin graft or suture.Results The other flaps survived and obtained healing by first intention except 1 flap which had partial necrosis with healing by second intention.The skin graft at donor site survived.All patients were followed up 5-17 months（mean,12 months）.The flaps had good color and texture without contracture.At last follow-up,the sensation recovered to S1-S3＋;in 7 cases undergoing nerve anastomosis,the sensation reached S3-S3＋,and it was better than that not undergoing nerve anastomosis（S1-S2）;in 5 cases receiving sartorius muscle tendon bridging,the hand function recovered satisfactorily except 1 case of total active movement（TAM） value 〉75% of contralateral TAM at last follow-up.According to the Chinese Medical Society of Hand Surgery function evaluation standards,the results were excellent in 8 cases and good in 2 cases.Conclusion The dissociative saphenous arteria flap is an effective way to repair skin defects of the upper limbs because of reliable blood supply and simple surgical procedure.