血流桥接型静脉皮瓣修复伴有指掌侧固有动脉缺损的手指创面

Blood bridge venous flap to repair finger wound with proper palmar digital artery defect

目的探讨血流桥接型静脉皮瓣在伴有指动脉缺损的手指创面中的应用方法及临床疗效．．方法自2007年2月至2016年9月．采用前臂静脉皮瓣游离桥接修复伴有指掌侧固有动脉缺损的手指创面1l例，受伤至手术时间1.5-6h（平均2．5h），血管缺损长度1.4～3.4cm（平均2．3cm），桥接一侧指掌侧固有动脉8例，桥接双侧指掌侧固有动脉3例。切取皮瓣面积为1．5cm×2．0cm～2．2cm×3．5cnq．供区创面直接缝合．结果术后1例皮瓣边缘部分坏死，经换药后脱痂愈合。其余皮瓣、指体均顺利成活，切口均I期愈合。术后11例均扶得随访．随访时间为6～20个月，平均lO个月。皮瓣色泽、质地好，温、痛、触觉恢复，外形不臃肿。按TAM系统评定法评定：优6例，良4例，可1例。供区仅留线状瘢痕，手腕屈伸活动不受限，对供区影响小。结论血流桥接型静脉皮瓣可同时重建患指血运并修复创面．对伴有指神经、肌腱缺损的患指，也可同时切取皮神经及掌长肌腱桥接修复．可以获得满意的效果。

Objective To explore the application and clinical effect of blood bridge venous flap in finger wound with proper palmar digital artery defect. Methods From February, 2007 to September, 2016, 11 cases of fin- ger wound with artery defect were repaired with forearm vein free flap by the way of bridging blood vessels. The time from injury to surgery was 1.5 to 6 hours （average 2.5 hours）. Vascular defect length was 1.4 to 3.4 em （average 2.3 cm）, 8 cases were bridged the unilateral digital artery and 3 cases were bridged the both side. The area of skin flap was 1.5 cm×2.0 em to 2.2 cm ~ 3.5 em and the donor site was sutured directly. Results One case appeared necrosis in marginal part and healed after dressing change. The other flaps and finger survived and the incisions healed well,All the 11 cases were followed up after operation. The follow-up time ranged from 6 to 20 months, aver- aged 10 months. The color and texture were well ,the sensation of temperature, pain and tactile were recovered, and the flap had good contour. According to TAM system evaluation method： 6 cases got excellent resuhs,4 cases were good, 1 case was poor. The donor site only had a linear scar and the flexion and extension of wrist were not limited. Conclusion Flow bridging venous flap can reconstruct the finger blood and repair the wound simultaneously. To the finger with nerve or tendon defect, bridged with the cutaneous nerve or palmaris longus tendon can also get satisfactory result.