股前外侧皮瓣修复拇指虎口及邻近组织毁损伤

Repair of mutilated wounds of thumb web and adjacent tissues with anterolateral thigh flap

目的探讨股前外侧皮瓣游离移植一期修复拇指虎口及邻近组织毁损创面的临床疗效。方法回顾性分析2014年3月至2018年3月南部战区总医院收治的8例拇指虎口毁损创面患者的临床资料。术前运用“三线法”设计皮瓣,术中仔细解剖皮瓣及血管蒂,形成以旋股外侧动脉外侧降支为主干并有多个分支的血管链,以及以第一穿支为蒂的股前外侧皮瓣;应用皮瓣覆盖创面,吻合皮瓣蒂部与受区血管、桡动脉腕背侧分支,修复拇指虎口。结果术后8例患者拇指虎口均获完整重建,移植皮瓣全部存活,拇指、示指血运良好。随访时间6~12个月,平均随访时间8.2个月。末次随访时按中华医学会手外科分会上肢部分功能评定试用标准:优3例、良5例。结论股前外侧皮瓣修复拇指虎口及邻近组织毁损伤,可最大限度地保留拇指的外展、内收及对掌功能,临床效果满意。

Objective To investigate the clinical effects of one-stage repair of mutilated wounds of thumb web and adjacent tissues with anterolateral thigh flap free transplantation.Methods Clinical data of 8 patients with smashed injuries of thumb web treated from March 2014 to March 2018,in General Hospital of Southern Theatre Command,were retrospectively analyzed.'Three-line method'was used to design the skin flap,then the flap and vascular pedicle were dissected carefully to form a vascular chain composed of the trunk of the lateral descending branch of lateral circumflex femoral artery and several muscular branches,and the anterolateral thigh flap pedicle on the first perforator.The flap was then used to cover the wounds while the pedicle of the flap was anastomosed to the recipient vessels and the dorsal carpal branches of radial artery to restore blood circulation to the thumb web.Results Wounds of thumb web of 8 patients were well reconstructed,and all free flaps survived.The thumbs and forefingers recovered good blood circulation.The patients were followed up from 6 to 12 months(average,8.2 months).According to the provisional functional assessment criterion for upper limbs issued by the Chinese Hand Surgery Society,there were excellent in 3 patients,and good in 5 patients at the latest follow-up.Conclusion One-stage repair of mutilated wounds of thumb web and adjacent tissues with anterolateral thigh flap could obtain satisfactory clinical outcome because of its preserving thumb functions of abduction,adduction and opposition as far as possible.