桡动脉腕横纹穿支皮瓣游离移植修复指腹缺损

Application of Free Grafting of Wrist Crease Radial Artery Perforator Flap for Repair of Defect of Finger Pulp

目的探讨桡动脉腕横纹穿支皮瓣游离移植修复手指指腹缺损的方法与效果。方法2015年3月~2016年3月我科采用桡动脉腕横纹穿支皮瓣游离移植修复手指指腹皮肤软组织缺损13例。其中,拇指2例,示指3例,中指4例,环指3例,小指1例。手指皮肤缺损面积(1.5 cm×1.8 cm)^(2.7 cm×2.5 cm)。结果本组13例患者中仅1例术后出现静脉危象,经拆线、侧切口放血后皮瓣整体成活,仅远端边缘坏死,后经换药痊愈,余患者皮瓣均顺利成活。本组患者均获随访,平均随访5.5(6~10)个月,皮瓣质地优良,耐磨,无色素沉着。按中华医学会手外科学会上肢部分功能评定试用标准评定临床疗效^([6]):优12例,可1例;优良率92.3%。术后8个月皮瓣两点辨别觉为5~8 mm,平均6.2 mm。供区无瘢痕挛缩,腕关节屈、伸活动无影响。结论桡动脉腕横纹穿支皮瓣修复指腹缺损,相比其他皮瓣,具有外形美观、耐磨、感觉恢复佳、供区直接闭合等特点,临床效果满意,应用前景广泛,适合在各基层医院开展。

Objective To explore the method and effect of free grafting of wrist crease radial artery perforator flap for repair for finger pulp defect. Methods The clinical data of 13 cases with soft tissue defect of finger pulp repaired by wrist crease radial artery perforator flap grafting from March 2015 to March 2016 were analyzed retrospectively. The pulp defect located in thumb in 2 cases,index finger in 3 cases,middle finger in 4 cases,ring finger in 3 cases and digitus quintus manus in one case. The defect area of finger ranged from（ 1. 5 cm× 1. 8 cm） to（ 2. 7 cm × 2. 5 cm）. Results Out of 13 patients,venous crisis occurred in one case and the flap survived after symptom treatment and dressing change. All cases were followed up for 6 to 10 months with an average of 5. 5 months. The flap showed well texture,wear-resisting and normal appearance. The clinical effect revealed excellence in 12 cases and fair in 1 case,and the fineness rate was 92. 3%. The two point discrimination was 5 to 8 mm with an average of 6. 2 mm. No cicatricial contracture was found in donor area,and wrist joint function was normal. Conclusion The wrist crease radial artery perforator flap can achieve reliable clinical effect for repair of finger pulp defect with advantages as satisfactory appearance,good wear-resisting,well sensation,and it deserves to be popularized.