个性化设计游离上臂外侧穿支皮瓣修复手部不规则皮肤软组织缺损

RECONSTRUCTION OF IRREGULAR DEFECTS OF HAND USING LATERAL ARM FREE PERFORATOR FLAP BY PERSONALIZED DESIGN

目的探讨个性化设计上臂外侧穿支皮瓣游离移植修复手部不规则皮肤软组织缺损的疗效。方法2010年1月~2015年1月,收治12例手部不规则皮肤软组织缺损患者。男7例,女5例;年龄18~52岁,平均35岁。致伤原因:挤压伤5例,热压伤3例,交通事故伤2例,摩擦伤2例。受伤至入院时间1.0~4.5h,平均3.1h。对3例近似正方形的皮肤软组织缺损,设计宽度<6cm的皮瓣并分割成分叶皮瓣修复创面;5例手部贯通伤,采用双叶皮瓣修复;4例多个手指皮肤软组织缺损,采用双叶或者三叶皮瓣修复。皮肤软组织总缺损范围6.0 cm×5.0 cm^9.0 cm×8.0 cm,皮瓣切取范围10.0 cm×3.5 cm^12.0 cm×6.0 cm。供区均直接缝合。结果术后皮瓣均顺利成活,创面及供区切口均I期愈合。患者均获随访,随访时间6~15个月,平均10个月。其中2例女性患者皮瓣略臃肿,术后3个月行皮瓣修整术。术后6个月皮瓣感觉恢复至S_1~S_3。手功能恢复满意,末次随访时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:优2例,良7例,可2例,差1例。供区仅遗留线性瘢痕。结论上臂外侧穿支皮瓣血管解剖恒定,肌间隔穿支丰富,通过个性化设计可修复手部不规则皮肤软组织缺损,且供区可直接拉拢缝合。

Objective To observe the effectiveness of lateral arm free perforator flap by personalized design in repairing irregular defects of the hand. Methods Twelve patients with irregular defects of the hand were repaired with lateral arm free perforator flaps by personalized design between January 2010 and January 2015. There were 7 males and 5 females with a mean age of 35 years （range, 18-52 years）. The causes included crush injury in 5 cases, thermal injury in 3 cases, traffic accident injury in 2 cases, and friction injury in 2 cases. The time between injury and admission was 1.0-4.5 hours （mean, 3.1 hours）. In 3 patients with skin and soft tissue defect of approximate square, the flap of less than 6 cm in width was designed and was segmented into foliated flaps to repair wound; the bilobed flaps were used in 5 cases of hand penetrating wounds; the bilobed flaps or trifoliate flaps were used in 4 cases of multiple finger skin soft tissue defects. The total area of the defects ranged from 6.0 cm^5.0 cm to 9.0 cm^8.0 cm, and the area of flap ranged from 10.0 cmx3.5 cm to 12.0 cmx6.0 cm. All the wounds at donor site were dosed directly. Results All the flaps survived, wounds and incisions at donor sites healed by first intention. The patients were followed up 6-15 months （mean, 10 months）. Bulky flaps were observed in 2 cases of female patients, and flap thinning was performed at 3 months after operation. The hand function recovered satisfactorily, and the sensation was S1-S3 at 6 months after operation. According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 2 cases, good in 7 cases, fair in 2 cases, and poor in 1 case. The linear scars was observed at the donor site. Condusion The lateral arm free perforator flap has constant vessels anatomy, and there are many perforators in the intermuscular septum. The lateral arm free perforator flap by personalized design can repair irregular defects of the hand.