吻合指背动脉的趾腓背侧动脉皮瓣修复手指背侧皮肤软组织缺损

TOE FIBULAR-DORSAL ARTERY FLAP ANASTOMOSED TO DORSAL DIGITAL ARTERY IN REPAIRING DORSAL SOFT TISSUE DEFECT OF FINGERS

目的探讨吻合指背动脉的趾腓背侧动脉皮瓣游离移植修复手指背侧皮肤软组织缺损的疗效。方法 2010年5月-2015年9月,收治28例手指背侧皮肤软组织缺损患者。男17例,女11例;年龄15~55岁,平均23.8岁。致伤原因:机器绞伤15例,重物压砸伤4例,锐器切割伤5例,热压伤4例。受伤至入院时间为30 min^12 h,平均1.5 h。损伤指别:拇指3例,示指8例,中指6例,环指6例,小指5例。软组织缺损范围2.0 cm×1.5 cm^3.5 cm×2.5 cm。切取大小为2.8 cm×1.7 cm^3.8 cm×2.8 cm的趾腓背侧动脉皮瓣游离修复缺损,趾腓背侧动脉、神经与静脉分别与患指指背动脉、神经及静脉吻合重建皮瓣血运及感觉。供区游离植皮修复。结果手术时间1.5~5.5 h,平均2.5 h;术中出血量10~50 m L,平均30 m L。术后1例皮瓣出现血管危象,经对症处理后皮瓣成活。其余皮瓣均顺利成活,创面Ⅰ期愈合。供区植皮均成活,切口Ⅰ期愈合。28例均获随访,随访时间6~24个月,平均8个月。皮瓣外形良好,术后6个月两点辨别觉为3.5~12.0 mm,平均5.3 mm。手指恢复抓捏功能,术后6个月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价,获优20例、良8例,优良率100%。足趾供区平整无凹陷,患者步态正常。结论应用游离趾腓背侧动脉皮瓣修复手指背侧皮肤软组织缺损,手指外观及功能恢复满意,达到修饰性修复效果,且供区损伤小。

Objective To discuss the effectiveness of free toe fibular-dorsal artery flap anastomosed to dorsal digital artery in repairing dorsal soft tissue defect of fingers. Methods Between May 2010 and September 2015, 28 patients with dorsal soft tissue defect of fingers were treated, including 17 males and 11 females with an average age of 23.8 years（range, 15-55 years）. The reasons of injuries were machine twist（15 cases）, heavy pound（4 cases）, the sharp cut（5 cases）, and hot crush（4 cases）. The time from injury to admission was 30 minutes to 12 hours（mean, 1.5 hours）. The involved fingers included thumb（3 cases）, index finger（8 cases）, middle finger（6 cases）, ring finger（6 cases）, and little finger（5 cases）. The area of soft tissue defects ranged from 2.0 cm×1.5 cm to 3.5 cm×2.5 cm, and the area of free toe fibular-dorsal artery flap ranged from 2.8 cm×1.7 cm to 3.8 cm×2.8 cm. The blood supply of the flaps were reconstructed by anastomosing the toe fibular-dorsal artery, vein, and nerve to the dorsal digital artery, vein, and nerve, respectively. The donor site was repaired by free skin graft. Results The operation time was 1.5-5.5 hours（mean, 2.5 hours）; the blood loss during operation was 10-50 m L（mean, 30 m L）. Vessel crisis occurred in 1 case, and the flap survived after symptomatic treatment. The other flaps survived and the wounds healed with stage I; the skin grafts at donor site survived and the incisions healed with stage I. Twenty-eight cases were followed up 6-24 months（mean, 8 months）. The appearance of flaps was good, and two-point discrimination was 3.5-12.0 mm（mean, 5.3 mm） at 6 months after operation. The fingers function of grab and pinch recovered. According to the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the results were excellent in 20 cases and good in 8 cases, with an excellent and good rate of 100% at 6 months after operation. The donor sites of toe were smooth and had no depression. The patients had normal gait. Conclusion Free toe fibular-dorsal artery flap anastomosed to dorsal digital artery in repairing dorsal soft tissue defect of fingers can obtain satisfactory effectiveness in appearance and function of fingers, and has the advantages of modified repair and less injury at donor site.