指掌侧固有动脉背侧支皮瓣修复指端软组织缺损35例

Repair of fingertip soft tissue defect with the dorsal branches island flaps of the proper palmar digital arteries： a report of 35 cases

目的 探讨指掌侧固有动脉背侧支皮瓣的临床应用方法和效果。方法自2010年1月至2015年2月．对20例第2-5指单个手指末节掌侧皮肤软组织缺损采用指掌侧固有动脉远节指骨基底部背侧穿支皮瓣修复，皮瓣切取面积3．5cm×2．5cm～2．0cmm×2．0cm。对15例第2-5指单个手指中、末节掌侧皮肤软组织缺损．采用指掌侧固有动脉近端1／3处背侧穿支皮瓣修复，皮瓣切取面积4．5cm×2．5cm～3．0cm×2．0cm。供区均采用全厚皮片植皮。分别于术后1、3、6个月对患指皮瓣的外形、质地、感觉恢复及植皮区质地、手指功能恢复情况进行随访。结果术后35例皮瓣全部成活，随访6～13个月，平均7个月。皮瓣外形饱满，质地优良，植皮区质地柔软。术后感觉恢复S2～s3两点辨别觉10～15mm。按中华医学会手外科学分会上肢部分功能评定试行标准：优23例，良10例，可2例。结论指掌侧固有动脉背侧支皮瓣切取方便、血供可靠、不牺牲知名主干血管、符合就近切取原则，是修复手指部软组织缺损的理想方法。

Objective To discuss the treatment method and effect of the application of the dorsal branches island flaps of the digital arteries in clinic. Methods During January, 2010 to February, 2015, a total of 20 cases of palmar soft tissue defect of the 2nd-5th distal segments of single fingers were incorporated and repaired by the dorsal branches island flaps of the digital arteries in the base of the distal phalanx. The size of the selected flaps was 3.5 cm × 2.5 cm-2.0 cm × 2.0 cm. In addition, palmar soft tissue defect （n = 15） of the 2nd-5th middle and distal segments of single fingers were repaired by the dorsal branches island flaps of the digital arteries at the 1/3 site of the proximal digital arteries, and the selected flaps size was 4.5 cm × 2.5 cm-3.0 cm × 2.0 cm. Full-thick- ness skin graft urethroplasty was used in the donor sites. Flap shape, texture, sensory recovery and texture of the skin region, function recovery of the wounded fingers were followed up at 1,3, and 6 months after operation. Resuits Thirty-five patients were followed up from 6 to 13 months （average of 7 months）. All flaps survived com- pletely in the incorporated 35 cases postoperatively. Flaps had satisfactory appearance, fine texture, and soft texture in the skin transplantation area. The postoperative improvement of sensmy function was between $2 and $3, and the two-point discrimination was 10-15 mm. Assessment of the upper limb function using the standard issued by the Hand Surgery Society of Chinese Medical Association graded 23 cases as excellent, 10 cases as good, and 2 cases as fair. Conclusion The dorsal branches island flaps of the digital arteries are characterized by easy dissection, reliable blood supply, and no major blood vessels needed to be sacrificed, which is an effective procedure for finger soft issue defect repairing.