骨间背侧动脉岛状皮瓣修复手部软组织缺损

Reconstruction of hand soft tissue defects with dorsal interosseous artery island flap

目的探讨骨间背侧动脉岛状皮瓣修复手部软组织缺损的临床效果。方法选择2009—2012年10例手部软组织缺损患者，其中男8例，女2例；年龄15～74岁。致伤原因：机械损伤4例，电击伤3例，慢性溃疡2例，热压伤1例。皮肤软组织缺损面积为3．0cm×2．5cm～12．0cm×7．0cm，皮瓣切取面积为4．0cm×3．0cm-13．0cm×8．0cm。利用便携式多普勒超声仪，探测前臂骨间背侧动脉发出的皮支，以骨间背侧动脉远端为血管蒂的逆行岛状皮瓣修复手部软组织缺损。观察皮瓣颜色、质地、感觉、供瓣区瘢痕情况。结果9例岛状皮瓣全部存活，1例皮瓣边缘部分坏死，换药后愈合。2例失访，8例获得3个月～1年随访，皮瓣色泽、感觉与邻近皮肤相近，质地柔软，感觉良好，供瓣区瘢痕增生不明显，其中1例皮瓣稍显臃肿。结论应用骨间背侧动脉岛状皮瓣修复手部软组织缺损安全有效。

Objective To evaluate the clinical effect of dorsal interosseous artery island flap to cover soft tissue defects of the hand. Methods Ten cases （8 males and 2 females ） treated between 2009 and 2012 were included. The age was from 15 to 74 years. There were 4 patients associated with mechanical injury, 3 electric injury, 2 chronic ulcer and 1 hot crush injury. Size of the defect ranged from 3.0 cm × 2.5 cm to 12.0 cm× 7.0 cm, and the size of the flap ranged from 4.0 cm× 3.0 cm to 13.0 cm× 8.0 cm. The portable Doppler ultrasound was employed to locate the branches from the forearm dorsal interosseous artery. The dorsal interosseous retrograde artery distally based was used to repair hand soft- tissue defects. Results All the flaps survived except for some necrosis in one case which healed after dressing change. Eight patients were followed up for 3 months to 1 year and two patients were lost to follow-up. Flap had soft texture and similar color and sensation as the adjacent skin. No apparent hypertrophic scarfing on the donor site was observed. Flap was slightly swollen in one case. Conclusion Dorsal interosseous artery retrograde island flap is safe and effective to repair hand soft tissue defects.