指根逆行岛状皮瓣血管危象的原因及补救方法

Reason and remedy of vascular crisis in finger root retrograde island flap transplantion

目的 总结和分析指根逆行动脉岛状皮瓣修复指端缺损术中出现血管危象的原因和补救方法.方法 对2005-2013年收治的285例指端缺损患者应用指根逆行岛状皮瓣修复.分析其中6例术中出现血管危象的原因,根据指动脉的解剖特点,切取后皮瓣的供血方式,将易损伤的部位分为三个区域.对于Ⅱ、Ⅲ区的损伤采用动脉直接吻合,将皮瓣内动脉与对侧动脉吻合的补救方法,重建皮瓣血供.同时将皮瓣内神经指背支与指固有神经残端缝合,以恢复皮瓣感觉.结果 本组6例皮瓣均顺利成活,随访5～8个月,皮瓣外形饱满,皮瓣质地与手指末端皮肤接近,患指活动功能无明显影响.结论 熟悉手部的解剖特点,了解指根逆行岛状皮瓣切取时易出现血管危象的原因.做好术前评估,术中无创操作.出现皮瓣血管危象后分析原因,采用将皮瓣内指固有动脉远端与对侧指固有动脉远端吻合的方法,重建皮瓣血供,提高皮瓣成活率,避免手术失败或改行其他术式增加损伤.

Objective To summarize and analyze the reasons and remedies of vascular crisis which happened during operation repairing fingertip defects with reverse island flap with terminal dorsal branch of digital artery. Methods From 2005 to 2013, 285 cases of fingertip defect were treated by using reverse island flap with terminal dorsal branch of digital artery in our hospital. To analyze the reason of vascular crisis in 6 cases, the easily injured regions were divided into three parts according to the anatomical characteristics of digital artery and the blood supply type after cutting flap. For the II and III regions patients, we used direct arterial anastomosis and anastomosed the flap internal artery with the contralateral artery] to reconstruct blood supply, at the same time, we still adopt the anastomosis of flap internal nerves and the residual proper digital nerves to restore feeling of flap. Results All the fingers recovered uneventfully. Postoperative follow-up interval ranged from 5 to 8 months. The appearance and function of the flaps were all satisfactory and the skin texture of flap was close to the skin of the fingertips. The activity function of wounded fingers was not affected. Conclusion To understand the anatomy of hands, the reason of vascular crisis in cutting reverse island flap with terminal dorsal branch of digital artery is needed. Good preoperative evaluation and noninvasive operation are necessary. We should analyze the reason of vascular crisis in operation and anastomose the flap internal arterial with the contralateral artery to reconstruct blood supply of flap. Consequently, we can improve the skin flap survival rate and avoid operation failure or changing the operation method that maybe increase damage.