游离足背皮瓣带趾伸肌腱修复手背复合组织缺损的临床应用

Clinical application of free dorsal foot skin flap with tendon of extensor digitorum for repair of compound tissue defects of the dorsum of hand

目的探讨游离足背皮瓣带趾伸肌腱修复手背皮肤、肌腱等组织缺损的临床疗效。方法自2008年5月至2015年12月对12例手背皮肤软组织缺损并伴不同程度伸肌腱缺损的患者采用带1—3条趾伸肌腱的游离足背皮瓣进行创面修复，其中急诊手术6例，另6例先行清创＋负压封闭引流技术（VSD）后，二期再行修复手术。结果本组12例带趾伸肌腱游离足背皮瓣全部存活，随访6—24个月，皮瓣质地及外形良好，伤手屈伸指功能恢复满意，皮瓣两点分辨觉为6-9mm。对供区足部外观功能影响轻微，行走及屈伸趾活动无明显影响。结论足背皮瓣血管恒定，皮肤及肌腱组织质地均与手背相近，带趾伸肌腱的游离足背皮瓣是修复手背部复合组织缺损的较好方法。

Objective To explore the clinical effects of free dorsal foot skin flap with tendon of extensor digitorum in the treatment of skin and tendon tissue defects of the dorsum of hand. Methods From May 2008 to December 2015, 12 patients with skin and tendon tissue defects of the dorsum of hand were repaired by free dorsal foot skin flap with 1 to 3 tendons of extensor digitorum. Of them 6 cases received emergency surgery, while others had secondary repair surgery after debridement and vacuum sealing drainage dressing （VSD）. Results All 12 cases survived uneventfully. The follow-up period ranged from 6 to 24 months. The appearance and texture of the flaps were good. The flexion and extension function of injured fingers recovered well. The two-point discrimination was 6 to 9 mm. There was little effect on the appearance and fimction of foot donor site. Conclusion Free dorsal foot skin flap with tendon of extensor digitorum is a good method to repair compound tissue defects of the dorsum of hand due to the vascular constancy of dorsal foot skin flap and the skin and tendon texture similarity between recipient and donor site.