腕掌侧微型游离皮瓣在手指皮肤软组织缺损中的临床应用

Clinical Application of Wrist Side Free Mini-flap in Reparing Skin Soft Tissue Defects of the Fingers

目的:探讨腕掌侧微型游离皮瓣修复手指皮肤软组织缺损创面的手术方法及疗效。方法:2015年2月-2016年10月,东莞仁康医院手足显微外科对收治的20例手指皮肤软组织缺损伴/不伴骨骼、肌腱损伤的患者,根据不同创面情况急诊行清创、腕掌侧微型游离皮瓣修复(包括静脉皮瓣、桡动脉掌浅支腕横纹皮瓣、尺动脉腕上皮支皮瓣),供区创面直接缝合。其中采用桡动脉掌浅支腕横纹皮瓣、尺动脉腕上皮支穿支皮瓣修复者携带皮神经。结果:全部20例皮瓣均成活,供区及受区切口皆Ⅰ期愈合。其中静脉皮瓣2例出现皮瓣边缘部分坏死,创面经换药后愈合。全部患者获随访,随访时间4～8个月,平均6个月。皮瓣质地柔软,外观功能满意,携带皮神经修复者皮瓣具有感觉功能。供区无瘢痕挛缩,腕关节屈、伸活动无受限。结论:腕掌侧微型游离皮瓣具有解剖恒定、手术操作方便、修复后皮瓣质量好、供区损伤轻微等优点,是修复手指缺损创面的良好的方法。

Objective:To discuss the application of wrist side free mini-flap in repairing the soft tissue defect on fingers.Method:From Feb 2015 to Oct 2016,20 patients with soft tissue defect on fingers,partially accompanied bone or tendon injury were treated by hand and foot microsurgery of Dongguan Renkang Hospital.According to different situation of wound,debridement in emergency and wrist side free mini-flap repair(include venous flap,wrist transverse skin flap and ulnar artery cutaneous branch flap).The donor sites were directly sutured.Wrist transverse skin flap and the ulnar artery cutaneous branch flap of the cutaneous branch of the ulnar artery carries the nerve were used.Result:Among the 20 patients,all the wounds at recipient and donor sites were healed at stageⅠ,and the free mini-flaps survival completely.Marginal necrosis of flap occurred in two venous flap cases.The wound of fingers healed after dressing changed. All of patients were followed up for 4-8 months(average 6 months).The flap was soft and the patients were satisfied with the appearance and function of the flap. The flap with cutaneous nerve repair had sensory function.Donor sites had no cicatricial contracture sotomy.Flexion and extension of wrist without limitation. Conclusion:Wrist side free mini-flap is an ideal method for repairs of wounds on fingers.This method has the advantages of constant anatomy,easy operation, good quality of repaired flap and slight injury of donor site.