带掌长肌腱的静脉皮瓣修复伴有肌腱缺损的指背创面

Appfication of venous flaps with palmaris longus tendon for repair of dorsal digital wound with tendon defect

目的探讨带掌长肌腱的静脉皮瓣修复伴有肌腱缺损的指背创面的临床疗效。方法白2010年10月至2013年10月，我们采用游离带掌长肌腱的静脉皮瓣修复伴有肌腱缺损的指背创面15例15指，其中13例采用静脉动脉化重建血供，2例采用静脉系统供血重建血供。结果术后皮瓣均存活，其中14例供区直接缝合，伤口Ⅰ期愈合；1例供区采用前臂近端取皮植皮，植皮成活。术后随访时间为3～18个月，平均12个月，手指外观及功能满意。按照肌腱修复术后TAM／TPM标准评价疗效：优8指，良4指，可2指，差1指。结论带掌长肌腱的静脉皮瓣修复伴有肌腱缺损的指背创面，一次手术能同时完成肌腱、皮肤缺损的修复，是一种较好的治疗方法。

Objective To investigate the clinical efficacy of venous flap with palmaris longus tendon in the treatment of dorsal digital wound with tendon defect. Methods From October 2010 to October 2013, 15 cases （15 fingers） of dorsal digital wound with tendon defect were treated with venous flap with palmaris longus tendon. Among them, blood supply was reconstructed by venous arterioles in 13 cases and by venous supply in 2 cases. Results All the flaps survived uneventfully. The donor site was sutured directly in 14 cases with primary healing and covered by skin graft from proximal forearm in 1 case with skin graft survival Postoperatively all the patients were follow-up for 3 to 18 months with an average of 12 months. The appearance and function of the affected fingers were satisfactory. According to the TAM/ TPM standard after tendon repair, the results were excellent in 8 fingers, good in 4 fingers, fair in 2 fingers and poor in 1 finger. Conclusion It is a good method to repair dorsal digital wound with tendon defect using venous flaps with palmaris longus tendon, because one operation can complete the repair of tendon and skin defect at the same time.