游离携带浅静脉的骨间后动脉皮瓣修复手指皮肤缺损

Free dorsal interosseous artery flap transfer along with a superficial vein for coverage of soft tissue defects in the finger

目的 探讨携带浅静脉的骨间后动脉皮瓣修复手指皮肤软组织缺损的临床疗效.方法 2009年1月至2013年1月,我们根据骨间后动脉走行与前臂背侧浅静脉交叉点为中心设计皮瓣,游离携带浅静脉的骨间后动脉皮瓣修复手指皮肤软组织缺损42例,骨间后动脉与指固有动脉吻合,皮瓣浅静脉与手（指）背浅静脉吻合.皮瓣切取面积为2.0cm×2.5cm～3.0 cm× 8.0 cm.结果 42例皮瓣全部存活,其中1例因静脉卡压出现静脉危象,皮瓣边缘放血后存活.术后随访时间为6～ 12个月,平均8.3个月,皮瓣颜色、质地良好,皮瓣恢复保护性感觉,供区仅留线性瘢痕,无肌肉粘连.结论 游离携带浅静脉的骨间后动脉皮瓣修复手指皮肤软组织缺损较少发生静脉危象,获得了较好的临床疗效.

Objective To present the surgical procedure of including a superficial vein in dorsal interosseous artery flap transfer for repairing soft tissue defects of the fingers and evaluate its clinical outcomes.Methods From January 2009 to January 2013,42 cases of soft tissue defects of the fingers were treated with this procedure.The flap was designed using the intersection between the dorsal interosseous artery projection and the forearm dorsal superficial vein as the pivot point.The dorsal interosseous artery flap was harvested to include the superficial vein and transferred to the fingers to cover the soft tissue defects.The dorsal interosseous artery was anastomosed to the digital artery,while the superficial vein in the flap was anastomosed to the superficial vein on dorsum of the finger.Flap areas ranged from 2.0 cm × 2.5 cm to 3.0 cm × 8.0 cm.Results All 42 flaps survived.Venous crisis occurred in one flap due to antrapment of the vein.Bloodletting from the edge of the flap reversed the crisis and led to flap survival.Postoperative follow-up ranged from 6 to 12 months,with an averagc of 8.3 months.The flaps had good color and texture.Protective sensation was restored.Only linear scar was left on the dorsal forearm donor site without any muscle adhesion.Conclusion Transfer of the dorsal interosseous artery flap with a superficial vein can reduce risks of venous crisis.It results in good clinical outcomes in covering soft tissue defects of the fingers.