桡动脉掌浅支蒂的腕掌侧嵌合骨皮瓣带蒂转移修复拇指复合组织缺损

Chimeric flap pedicled with the paimar branch of the radial artery from the wrist crease area for repairing complex tissue defect of the thumb

目的探讨桡动脉掌浅支蒂的腕掌侧嵌合骨皮瓣带蒂转移修复拇指皮肤软组织伴指骨复合缺损的术后疗效。方法回顾性分析2013年6月至2015年6月收治的11例拇指复合组织缺损患者资料，男7例，女4例；年龄16-56岁，平均31．5岁；患指皮肤软组织缺损为3．0cmx1．3cm-6．3cmx2．0cm，骨缺损为1．3cmx0．8cmx0．4cm-2．8cmx1．3cmx0．8cm；均应用桡动脉掌浅支蒂的腕掌侧嵌合骨皮瓣带蒂转移修复，术中切取以桡动脉掌浅支为蒂的腕横纹皮瓣和桡骨远端骨瓣，经大鱼际部皮下隧道带蒂转移至拇指创面，修复复合组织缺损；皮瓣面积4．0cmx1．5cm-7．0cmx3．0cm，骨瓣体积为1．5cmx1．0cmx0．5cm-3．0cmx1．5cmx1．0cm。术后按中华医学会手外科学会上肢部分拇手指再造功能评定试用标准评定患指功能。结果11例嵌合骨皮瓣均全部成活，骨瓣愈合时间1．5-3个月，平均1．6个月。移植骨无一例发生骨吸收；患指功能、外观恢复良好；供区瘢痕轻微。术后6个月，患指皮瓣两点辨别觉为5．5-9.0mm，平均7．1mm。末次随访时，按中华医学会手外科学会上肢部分拇手指再造功能评定试用标准评定患指功能，其中优9例，良1例，可1例，优良率为90．9％（10／11）。结论桡动脉掌浅支蒂的腕掌侧嵌合骨皮瓣带蒂转移可同时修复拇指的皮肤软组织缺损和骨缺损，具有手术操作简便、血供安全、骨折愈合快、功能恢复好、供区瘢痕隐蔽等优点，是修复拇指复合组织缺损的新选择。

Objective To investigate the surgical method and clinical effect of chimeric flap pedicled with the palmar branch of the radial artery from the wrist crease area for repairing the complex defect of the thumb. Methods Data of 11 cases with thumb complex tissue defects admitted during June 2013 to June 2015 were retrospectively analyzed. There were 7 males and 4 females, aged from 16 to 56 years, with an average age of 31.5 years. The soft tissue defect of the affected finger ranged from 3.0 cmx1.3 cm to 6.3 cmX2.0 cm, and the bone defect ranged from 1.3 cmx0.8 cmx0.4 cm to 2.8 cmx1.3 cmx0.8 cm. All the cases were repaired by chimeric flap pedicled with the superficial palmar branch of radial artery of the wrist crease area. The chimeric flap was transferred through the thenar part of the subcutaneous tunnel to the thumb surface to repair the defect of the composite tissue. The flap area ranged from 4.0 cmx1.5 cm to 7.0 cmx3.0 cm and the bone flap size ranged from 1.5 cmx1.0 cmX0.5 cm to 3.0 cmX 1.5 cmx 1.0 cm. The function of the finger was evaluated postoperatively according to the upper extremity functional tentative evaluation criteria of thumb and finger reconstruction by Hand Surgery of Chinese Medical Association. Results All 11 cases of wrist transverse bone flap survived. The average healing time of the bone flap was 1.6 （range, 1.5-3） months, and the bone graft was not absorbed. The function and appearance of the finger was good with only a linear scar; 6 months after surgery, the two- point discrimination on average was 7.1 mm （range, 5.5-9.0 mm）. At the latest follow-up according to the upper extremity function- al tentative evaluation criteria of thumb and finger reconstruction by Hand Surgery of Chinese Medical Association, finger function were excellent in 9 cases, good in 1 case, with the excellent rate of 90.9% （10/11）. Conclusion The chimeric bone flap pedicled with the superficial palmar branch of radial artery can repair skin, soft tissue and bone defects of thumb simultaneously. It has the advantages of simple operation, safe blood supply, speeding up fracture healing, good functional recovery and concealed scar in donor area. It is a new choice to repair the complex tissue defect of thumb.