逆行第一掌背桡侧动脉链状血管吻合穿支皮瓣修复拇指掌侧皮肤缺损

Reconstruction of pulp defects of the thumbs with the first dorsal metacarpal radial artery linear vascular anastomosis perforator reversed flap

目的总结携带第一掌背桡侧皮神经的逆行第一掌背桡侧动脉链状血管吻合穿支皮瓣修复拇指掌侧皮肤缺损的临床效果。方法遵义医学院附属医院烧伤整形外科2010年1月至2015年4月收治拇指掌侧皮肤缺损25例,男16例,女9例;年龄15~55岁,平均（25±1）岁。爆炸伤5例,机器绞伤7例,电锯伤13例。缺损范围为2.0 cm×1.5 cm至4.0 cm×3.0 cm。术中切取2.5 cm×2.0 cm至4.5 cm×3.5 cm的逆行第一掌背桡侧动脉链状血管吻合穿支皮瓣修复拇指掌侧皮肤缺损,皮瓣携带第一掌背桡侧皮神经,并与指固有神经吻合重建感觉。供瓣区宽度〈3.0 cm直接缝合,≥3.0 cm者于前臂内侧切取全厚皮片植皮修复;术后随访观察6~24个月,平均12个月。结果术后25例皮瓣全部成活,植皮均成活。均获得随访,皮瓣质地优良、不臃肿,外形满意,无需再次手术整形,9例两点辨别觉为5 mm,7例两点辨别觉为6 mm,6例两点辨别觉为7 mm,3例两点辨别觉为8 mm。结论携带第一掌背桡侧皮神经的逆行第一掌背桡侧动脉链状血管吻合穿支皮瓣外形好,术后感觉恢复满意,是修复拇指掌侧皮肤缺损的理想方法之一。

Objective To conclude the clinical effects of repair of pulp defects of the thumbs with the first dorsal metacarpal radial artery linear vascular anastomosis perforator reversed flap which carries the first dorsal metacarpal radial cutaneous nerve. Methods From January 2010 to April 2015, Department of Burn and Plastic Surgery of Affiliated Hospital of Zunyi Medical College treated 25 cases of pulp defects of the thumbs. There were 16 males and 9 females. With an average age of 25±1 （ranged, 15-55）, including 5 cases of blast injury, 7 cases of machine injury and 13 cases of chainsaw injury. Defect area ranged from 2.0 cm×1.5 cm to 4.0 cm×3.0 cm. The first dorsal metacarpal radial artery linear vascular anastomosis perforator reversed flap was used in all the pulp defects of the thumbs, meanwhile anastomosed the first dorsal metacarpal radial cutaneous nerve with inherent nerve of thumb to reconstruct sensation. The area of these flaps was from 2.5 cm×2.0 cm to 4.5 cm×3.5 cm. Sutured directly the donor site when its width is less than 3.0 cm, more than 3.0 cm for repairing with full thickness skin graft. The mean follow-up period was 12 months （ranged, 6 months to 24 months）. Results All the 25 flaps and skin graft survived completely after operation. For follow-up, all the flaps quality were good, not bloated, and had satisfactory appearance, as well didn＇t need plastic surgery again. Two-point discrimination of 9 flaps was 5 mm, 6 mm in 7 cases, 7 mm in 6 cases and 8 mm in 3 cases. Conclusion The first dorsal metacarpal radial artery linear vascular anastomosis perforator reversed flap carrying the first dorsal metacarpal radial cutaneous nerve, is an ideal method to repair the pulp defects of the thumbs for satisfactory appearance and satisfactory recovery of sensation.