双叶式腹壁下动脉穿支皮瓣移植修复全手套状撕脱伤

Clinical application of bilobed deep inferior epigastric perforator flap to repair degloving injury of hand

目的探讨双叶式腹壁下动脉穿支皮瓣（DIEP）修复全手套脱伤的方法和临床效果。方法以腹壁下动脉与腹壁上动脉和肋间后动脉之间血管吻合的解剖学研究为基础，自2013年6月至2015年1月，对6例全手套脱伤患者设计切取双叶式DIEP移植修复，其中较小一叶皮瓣（副叶）单独修复拇指创面，较大一叶皮瓣（主叶）修复第2～5指及掌背创面。结果皮瓣主叶切取最大面积35cm×12cm，副叶10cm×7cm，术后6例皮瓣全部成活，1例出现皮瓣远端部分表皮坏死，经换药后愈合。所有病例随访6～20个月，平均12个月，皮瓣外观及患手功能恢复较满意。皮瓣基本完全恢复保护性感觉，拇指对掌功能及关节自主活动度恢复较好。按中华医学会手外学会上肢部分功能评定标准评定：优3例、良2例、1例。供区创面一期闭合，外观良好。结论双叶式DIEP血供可靠，可切取面积大，供区创伤小，是修复全手套状撕脱伤的较好选择。

Objective To discuss the method and clinical effect of bilobed DIEP flap for repair of degloving injuries of the hand. Methods From June, 2013 to January, 2015, the bilobed DIEP flap were designed to repair 6 cases of degloving injuries of hand, of which the small leaf flap repaired separately defect of thumb, larger leaf flap repair 2nd-Sth finger and palm and dorsum. The bilobed DIEP flap design were based upon anatomic study on deep inferior epigastric artery, superior epigastric artery, intercostal artery and its anastomosis. Results The largest area of main flap was 35 cm × 12 cm, and the deputy leaves of flap was 10 cm × 7 cm. All of the 6 flaps survived. One of them experienced distal end necrosis of epidermis. But it was healed by dressing changes. All of the 6 cases were followed up for average of 12 months （range, 6-20 months）. All flaps were seen with good appearance, fully recovered protective sensation and the active motion of the thumb was recovery. Moreover, the donor sites were closed directly and the appearance were satisfactory. Conclusion The bilobed DIEP flap is a satisfying choice in repairing degloving injuries of the hand in that it has reliable blood supply, can obtain the larger area of skin and leaves small injuries in targeted area.