吻合血管的前臂中段尺动脉穿支皮瓣修复手指皮肤软组织缺损

Ulnar artery perforator flap of the middle part of forearm with blood vessel anastomosis for repair of finger skin and soft tissue defects

目的评价前臂中段尺动脉穿支皮瓣修复手指创面的临床疗效。方法白2013年1月至2015年2月，我们对8例手指皮肤软组织缺损患者，采用前臂中段尺动脉穿支皮瓣游离移植修复。术后3、6、12个月进行随访，调查患者对皮瓣的满意度及恢复T作情况，检查术后皮瓣痛触觉、温度觉及两点分辨觉。结果所有皮瓣均顺利存活，供区伤口均I期愈合，1例二期行皮瓣整形术。术后随访12个月，所有患者对手指修复后的外观满意。6例患者再次回到原T作岗位。患指总主动活动度（TAM）与健侧的比值，术后3个月为0．73±0．16，术后6个月0．85±0．13，术后12个月0．92±0．15。所有患者在术后6个月均恢复皮瓣痛觉、温度觉及轻触觉。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：优4例，良3例，可1例。结论前臂中段尺动脉穿支皮瓣穿支位置恒定，血供可靠，术后外形功能恢复良好，适合修复手部较小创面。

Objective- To evaluate the clinical effects of the ulnar artery perforator flap in the middle segment of forearm for repair of finger skin and soft tissue defect of fingers. Methods From January 2013 to February 2015, 8 patients with finger skin and soft tissue defects were treated by free transplantation of the ulnar artery perforator flap in the middle segment of forearm. The follow-up was performed at 3, 6 and 12 months postoperatively. The patients＇ satisfaction of the skin flaps and the return to work were investigated. The postoperatively tactile sensation, temperature sensation and two-point discrimination of the skin flaps were examined. Results All the flaps were survived uneventfully. All the wounds in donor sites achieved primary healing. Flap second-stage debulking was performed in 1 case. After a follow- up period of 12 months, all the patients were satisfied with the appearance of the repaired fingers. 6 patients returned to the original job. The ratio of the injured side to the healthy side of the total active motion （TAM） was 0.73±0.16 at 3 months postoperatively, 0.85±0.13 at 6 months postoperatively and 0.92±0.15 at 12 months postoperatively. All the patients recovered the skin flap pain, temperature and light touch sensation at 6 months after the operation. According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were graded as excellent in 4 cases, good in 3 cases, and fair in 1 case. Conclusion The ulnar artery perforator flap in the middle segment of forearm has the advantages of constant position of the perforating branch and reliable blood supply. The postoperative recovery of the shape and function is good, and it is suitable for repair of small hand wound.