患侧前臂两种血流桥接皮瓣修复手指掌侧创面

Flow-through forearm flaps in palmar finger reconstruction

目的 探讨患侧前臂两种游离血流桥接皮瓣修复手指掌侧皮肤、动脉复合缺损的方法及疗效.方法 选择2011年9月-2014年2月收治的手指掌侧皮肤软组织合并指固有动脉缺损患者15例（15指）.致伤原因：切割伤6例,挤压伤5例,电锯伤4例.手指远端血运差11指,血运无4指.均为急诊Ⅰ期采用患侧前臂两种游离皮瓣以血流桥接方式移植修复损伤的手指动脉和皮肤缺损,其中动脉化的静脉皮瓣（AVF）修复9例,桡动脉掌浅支（SPBRA）皮瓣修复6例.根据中华医学会手外科学会上肢部分功能评定试用标准评定患指修复后疗效,比较两组皮瓣术后的感觉及手指活动度.结果 15例皮瓣均存活,手指血运恢复.4例AVF出现水泡,持续5～10d,未经特殊处理,自行愈合;其他创面均Ⅰ期愈合.术后随访8～12个月,成活皮瓣外观、质地和厚度接近手指掌侧受区,有保护性感觉,手指使用正常.患指修复后疗效：AVF获优6例,良2例,差1例,优良率为89％;SPBRA皮瓣获优4例,良1例,差1例,优良率为83％.术后12个月两组皮瓣两点辨别觉：AVF为6～9 mm[（7.6±1.3）mm],SPBRA皮瓣为7～11 mm[（8.5±3.1）mm]（P＞0.05）.手指活动度按照总主动活动系统评定方法（TAM）：AVF为（196.9±0.6）°,SPBRA皮瓣为（196.2±0.5）°（P＞0.05）.结论 AVF、SPBRA皮瓣均可较好地修复手指掌侧创面并重建指体的血运,是修复手指掌侧中小面积皮肤伴指动脉缺损的理想方法.

Objective To report the treatment and outcome of two kinds of flow-through forearm flaps in repairing palmar digital skin and artery defects.Methods The study included 15 patients （15 fingers） with palmar digtial skin combined with digital artery defects hospitalized from September 2011 through February 2014.Cut injuries were noted in 6 patients,crush injuries in 5 patients,and chain saw in 4 patients.There were 11 fingers with poor blood supply to the distal area and 4 no blood supply.One-stage reconstruction of the finger composite tissue defects was performed with flow-through free flaps including arterialised venous flaps （AVF） in 9 patients and superficial palmar branch of the radial artery （SPBRA） flaps in 6 patients.Discriminative sensation on the flap and active range of motion of the injured finger were analyzed and compared between the two groups.Results All the flaps survived and blood circulation in the finger restored.In AVF group,blister developed in 4 patients but healed within 5-10 days with no special care.Other than this the wound healed by the first intention.At a follow-up of 8-12 months,all the flaps that survived exhibited good restoration of the appearance,texture,thickness and protective sensation and the finger function was restored.According to the replanted finger function scoring system of Society of Hand Surgery of Chinese Medical Association,there were 6 excellent,2 good,and 1 poor results in AVF group,with the excellent-good rate of 89%;there were 4 excellent,1 good,and 1 poor results in SPBRA group,with the excellent-good rate of 83%.At postoperative 12 months,the two-point discrimination of the flaps was 6-9 mm [（7.6 ± 1.3） mm] in AVF group versus 7-11 mm [（8.5 ± 3.1） mm] in SPBRA group （P 〉 0.05）.Total active motion （TAM） of the injuredfingers was （196.9 ± 0.6） ° in AVF group and was （196.2 ± 0.5） ° in SPBRA group （P 〉 0.05）.Conclusion SPBRA flaps and AVF are both effective to cover digital wounds and restore blood circulation by flow-through technique.