分叶串联游离静脉皮瓣在双手指近中节软组织缺损修复中的应用

APPLICATION OF THE DOUBLE SKIN PADDLE ARTERIALIZED VENOUS FLAPS FOR RECONSTRUCTING SOFT TISSUE DEFECTS OF MIDDLE AND PROXIMAL PARTS OF DOUBLE FIGURES

目的探讨采用一套供血系统的分叶串联游离静脉皮瓣修复2个手指近中节软组织缺损的方法及临床疗效。方法 2011年9月-2014年12月采用仅用一套供血系统的分叶串联游离静脉皮瓣修复2个手指近中节软组织缺损创面6例。男5例,女1例;年龄19~52岁,平均33.8岁。致伤原因:绞割伤4例,挤压伤2例。患指位于示指5指、中指3指、环指2指、小指2指。所有患者均为手指近中节皮肤软组织缺损,缺损平面不超过远侧指间关节,缺损范围2.5 cm×2.5 cm^5.5 cm×4.0 cm;均有不同程度骨或肌腱外露,伴指骨骨折2例。伤后至手术时间为1.5~7 h,平均3.5 h。切取皮瓣范围8 cm×3 cm^14 cm×5 cm;供区宽度≤3.0 cm者直接缝合,>3.0 cm者取腹部全厚皮片植皮修复。结果患者手术时间为2.5~5.0 h,平均4.0 h。术后皮瓣全部成活;4例出现张力性水疱,拆除蒂部及局部张力较大处2~3根缝线,1周左右逐渐好转。5例患者皮瓣及供区创面均Ⅰ期愈合;1例其中1指皮瓣边缘部分坏死,二期清创直接缝合后Ⅰ期愈合,另1指皮瓣愈合良好。6例均获随访,随访时间6~18个月,平均13个月。皮瓣质地、弹性良好,外观饱满。末次随访时手功能按中华医学会手外科学会上肢部分功能评定试用标准评定,获优3例、良2例、可1例;皮瓣两点辨别觉为8~10 mm,平均9 mm。结论利用一套供血系统的分叶串联游离静脉皮瓣修复2个手指近中节软组织缺损,手术简便、疗效确切。

Objective To investigate the application of the double skin paddle arterialized venous flaps for reconstruction of soft tissue defects in the middle and proximal parts of double fingers. Methods Between September 2011 and December 2014, 6 cases（12 fingers） of soft tissue defects in the middle and proximal parts of double fingers underwent reconstructive surgery with the double skin paddle arterialized venous flaps. There were 5 males and 1 female with an average age of 33.8 years（range, 19-52 years）. The causes included cut injury in 4 cases and crush injury in 2 cases. Five index fingers, 3 middle fingers, 2 ring fingers, and 2 little fingers were involved. All defects located at proximal and middle fingers and defect did not exceed the distal interphalangeal joint. The defect area ranged from 2.5 cm×2.5 cm to 5.5 cm×4.0 cm. All cases had bone or tendon exposure, and 2 cases had phalangeal fracture. The disease duration was 1.5-7 hours（mean, 3.5 hours）. The flap size was 8 cm×3 cm-14 cm×5 cm. The donor site was directly sutured（≤ 3.0 cm in width） or was repaired with skin graft（3.0 cm in width）. Results The operation time was 2.5-5.0 hours（mean, 4.0 hours）. All flaps survived completely. Tensive blisters occurred in 4 cases and were improved at 1 week after removal of suture around pedicle. Partial distal flap necrosis was noted in 1 case, healing was obtained after secondary debridement; other wounds healed in one stage. The patients were followed up 6-18 months（mean, 13 months）. The flap had good texture, elasticity, and appearance. According to the hand function evaluation criteria issued by the Chinese Hand Society, the results were excellent in 3 cases, good in 2 cases, and fair in 1 case at last follow-up. The two-point discrimination of the flap was 8-10 mm（mean, 9 mm）. Conclusion The double skin paddle arterialized venous flaps have the advantages of simple technique and definite effectiveness for reconstruction of soft tissue defects in the middle and proximal part of double fingers.