桡动脉掌浅支血流桥接皮瓣在复杂性断指再植中的应用

Replantation of the complex amputated digital by using the flow-through flap based on the radial artery superficial palmar branch from palmar wrist area

目的 探讨腕横纹部桡动脉掌浅支血流桥接皮瓣应用于复杂性断指再植的可行性及临床疗效.方法 回顾性分析2012年1月-2015年2月徐州仁慈医院手足显微外科收治的11例复杂性断指患者的临床资料.其中男7例,女4例;年龄18-41岁,平均29.5岁.患指均血运障碍,伴皮肤软组织缺损范围1.5 cm×2.5 cm-3.0 cm×6.0 cm,指动脉缺损长度1.0-3.5 cm.患者均采用腕横纹部桡动脉掌浅支游离皮瓣桥接进行断指再植,观察患者患指成活情况,术后1年参照中华医学会手外科学会断指再植功能评定试用标准评定患指功能.结果 本组11例,10例顺利完成手术,1例因桡动脉掌浅支的浅支血管缺如,改行静脉皮瓣完成手术.10例患者术后皮瓣及患指均顺利成活,创面及供区切口一期愈合.患者均获随访12-18个月,平均15.5个月.末次随访时患者皮瓣颜色及质地与周围皮肤相似,供区无明显瘢痕,腕部功能正常.术后1年患指功能优8例,良1例,差1例,劣0例.结论 腕横纹部桡动脉掌浅支血流桥接皮瓣的血管蒂与指动脉口径匹配,适宜用于复杂性断指再植.

Objective To investigate the application methods and clinical outcomes of using the flow-through flap based on radial artery superficial palmar branch from palmar wrist area to replant complex amputated digital.Methods The clinical data of 11 patients with complex amputated fingers treated in the Hand and Foot Microsurgery Department of Xuzhou Renci Hospital from January 2012 to February 2015 were analyzed retrospectively.There were 7 males and 4 females, aged from 18 to 41 years, with an average age of 29.5 years.All the blood vessels in the affected fingers were interrupted.The extent of skin soft tissue defect ranged from 1.5 cm ×2.5 cm to 3.0 cm×6.0 cm, and the length of digital artery defect ranged from 1 to 3.5 cm.The flow-through flaps based on the superficial palmar branch of the radial artery from the wrist were used to replant the amputated fingers.The survival condition of the finger was observed.The function of the affected finger was assessed one year later, according to the standard of functional evaluation of finger replantation in Chinese Medical Association.Results In 11 cases, 10 cases completed the operation successfully.Because of the radial artery palmar superficial variation, 1 case was diverted to use venous flap to complete the operation.The flaps and fingers of the 10 patients survived successfully.The wounds and the donor sites were healed by first intention.All the patients were followed up from 12 to 18 months （average 15.5 months）.The color and texture of the flaps were similar to those of the surrounding skin at the last follow-up.There was no scar in the donor site, and the wrist function was normal.The digitals function was assessed 1 year post-operation, excellent in 8 cases, good in 1 case, fair in 1 case.Conclusions The vascular pedicle is well matched with the digital artery.The flow-through flap based on radial artery superficial palmar branch from palmar wrist area is suitable for the complex amputated digitals replantation.