以掌背动脉为蒂的接力皮瓣修复指背供区创面的临床应用

Clinical application of sequential flap pedicled with the dorsal metacarpal artery for repair of the woundof donor site at the dorsum of the finger

目的讨论以掌背动脉为蒂的接力皮瓣修复指背供区创面的操作方法、治疗效果及临床意义。方法白2014年8月至2016年8月应用指动脉近节背侧支皮瓣修复指中节皮肤缺损患者6例6指，中节指背皮瓣供区以掌背动脉为蒂的接力皮瓣修复，掌背部皮瓣供区直接缝合。切取皮瓣面积3．0cm×2．0cm～4．0cm×2．5cm。结果术后6例6指移植皮瓣均完全存活，平均住院时间10d，随访时间为6-12个月，近节指背皮瓣质地、色泽、饱满度、弹性满意，伤指活动功能满意，无肌腱粘连和指关节僵硬等并发症。掌背供区外观满意，未见瘢痕增生。患者对伤指的外形和功能满意。结论以掌背动脉为蒂的接力皮瓣修复近节指背皮瓣供区兼顾耐用性和外观，利于伤指的早期康复锻炼，对供区伤害小。手术方式安全简单，是对指动脉背侧支皮瓣供区修复的改进。

Objective To discuss the operation method, treatment effects and clinical significance of sequential flap pedicled with the dorsal metacarpal artery for repair of the wound of donor site at the dorsum of the finger. Methods From August 2014 to August 2016, 6 cases （6 fingers） with soft tissue defects at middle segment of the finger were treated with the proximal dorsal digital flap, and the donor site at dorsum of the middle segment of the finger was covered by sequential flap pedicled with the dorsal metacarpal artery. The donor sites of the dorsal metacarpal flaps were sutured directly. The flap sizes ranged from 3.0 cm×2.0 cm to 4.0 cm×2.5 cm. Results All the flaps survived uneventfully. The average hospitalization time was 10 days. All the patients were follow-up for 6 to 12 months postoperatively. The texture, color, plumpness and elasticity of the proximal dorsal digital flap were satisfactory, as well as the motor function of injured fingers. No tendon adhesion and joint stiffness occurred. The dorsal metacarpal donor sites achieved satisfactory appearance without scar hyperplasia. All the patients were satisfied with the appearance and function of injured fingers. Conclusion Application of sequential flap pedicled with the dorsal metacarpal artery for repair of the wound of donor site at the dorsum of the finger is beneficial to the early rehabilitation of the injured fingers because of good appearance and durability. The operation method is safe and simple, and has little damage to the donor site. Therefore, it is an improvement of repairing the donor site of digital arterial dorsal branch flaps.