骨间背筋膜瓣加延期植皮修复手背缺损

Distally based posterior interosseous adipofascial flap with delayed skin grafting for soft-tissue reconstruction of the dorsal hand

目的报告骨间背筋膜瓣加延期全厚皮片移植修复手背创面的临床效果。方法自2012年3月至2014年5月，对16例手背皮肤软组织缺损患者，急诊采用骨间背筋膜瓣修复，切取筋膜瓣面积5cm×4cm～10cm×6cm。术后7d，取腹股沟全厚皮片覆盖筋膜瓣。术后末次随访，根据温哥华瘢痕评定量表来评估供区外观及质革，通过Likert五点量表来评估患者对重建区外观的满意度。结果术后15例完全存活，1例筋膜瓣远端5％坏死。所有患者植皮完全成活。随访6～12个月，平均8个月，修复部位质地、外形、色泽恢复满意。温哥华瘢痕评定量表得分平均0．8分。Likeri五点评分表法得分平均17分。结论骨间背筋膜瓣加延期植皮是一种修复手背皮肤软组织缺损的理想方法。

Objective To investigate the clinical results of reverse interosseous adipofascial flap with delayed skin grafting in the reconstruction of defects on the dorsal hand. Methods From March 2012 to May 2014, 16 patients with soft tissue defects on the dorsum of the hand were treated dorsal interosseous adipofascial flap in emergency setting. The size of the flaps ranged from 5 cm × 4 cm to 10 cm×6 cm. The donor site at the forearm was closed directly. Seven days later, the faseial flap was covered with a full-thickness skin graft taken from the groin area. Vancouver Scar Scale was applied to assess the donor site scar. Five-point Likert scale was used to evaluate the appearance of the recipient site. Results One patient had partial loss of the flap involving 5% of the area at the distal end. All the other flaps survived corrlpletely. The skin grafts took well in all 16 patients. The duration of postoperative follow-up ranged from 6 to 12 months, with an average of 8 months. The texture and color of the skin graft were good, and the esthetic result was satisfactory. The mean score of Vancouver Sear Scale was 0.8. The mean score of Five-point Likert scale was 17. Conclusion The described adipofascial flap transfer with delayed skin graft is rather easy to perform without causing significant functional and aesthetic deficits to the donor site. It is a good method for repairing defects of the dorsal hand.