游离骨间背侧动脉桡侧穿支皮瓣在手部软组织缺损中的应用

The application of free dorsal interosseous artery radial perforator flap in repairing soft tissue defects of the hand

目的总结应用骨间背侧动脉桡侧穿支皮瓣修复手部软组织缺损的方法与临床效果。方法自2010年5月至2014年10月，我们采用游离骨间背侧动脉桡侧穿支皮瓣对8例手部软组织缺损患者进行修复，其中手指软组织创面4例，虎口软组织创面2例，手背侧软组织创面2例。并以前臂后侧皮神经重建皮瓣感觉，皮瓣切取面积为3．5cm×1．5cm-6．5cm×4．5cm。结果术后8例皮瓣全部存活，随访时间为6～12个月，皮瓣外形满意，手指、虎口功能恢复良好，皮瓣两点分辨觉恢复至8—11mm。供区仅留线性瘢痕，无功能影响。结论以骨问背侧动脉桡侧穿支为蒂的筋膜皮瓣，具有血供可靠、切取方便、皮瓣内有感觉神经支配、供区损伤小、不臃肿等特点，是修复手部小面积缺损的理想方法之一。

Objective To summarize the methods and clinical outcomes of applying dorsal interosseous artery radial perforator flap to repair soft tissue defects of the hand. Methods Between May 2010 and October 2014, 8 cases of soft tissue defects of the hand were treated with dorsal interosseous artery radial perforator flap transfer. There were 4 cases of soft tissue defects of the fingers, 2 cases of defects of the first web and 2 cases of soft tissue defects on the dorsum of the hand. The posterior antebrachial cutaneous nerve was used to restore sensation. The sizes of the flap ranged from 3.5 cm × 1.5 cm to 6.5 cm × 4.5 cm. Results All 8 flaps survived. The patients were follow-up for 6 to 12 months. The flaps had satisfactory appearance. Function of the fingers and the first web was good. Two-point discrimination was 8 to 11 mm. The donor site had no functional impairments with only linear sear. Conclusion The fasciocutaneous flap pedicled on the dorsal interosseous artery radial perforator is thin, easy to harvest, has reliable blood supply and sensory nerve iunervation, and causes minimal damage to the donor site. It is one of the ideal flaps for repairing small defects of the hand.