游离同侧多块小腿腓浅动脉穿支皮瓣修复手部多发创面效果观察

Multiple free homologous superficial peroneal artery perforator flaps of crus for repair of multiple hand wounds

目的探讨游离同侧多块小腿腓浅动脉穿支皮瓣修复手部多发创面的效果。方法2017年11月—2018年12月,笔者单位收治8例患者手部18处创面,其中4例分布于示、中指,2例分布于中、环指,1例分布于示、中、环指,1例分布于中、环、小指,手部缺损面积为1.5 cm×0.8 cm^4.0 cm×3.0 cm。患者中男4例、女4例,年龄34~62岁。6例患者游离同侧2块小腿腓浅动脉穿支皮瓣修复创面,2例患者游离同侧3块小腿腓浅动脉穿支皮瓣修复创面,术中将皮瓣腓浅动脉及其伴行静脉与受区指动脉及掌侧或背侧皮下静脉端端吻合。皮瓣切取面积2.5 cm×1.2 cm^5.0 cm×4.0 cm。术中均未切取神经,供瓣区均直接缝合。记录皮瓣存活情况,供瓣区愈合后情况,随访观察供受区恢复情况。结果术后皮瓣均存活良好,供瓣区愈合良好,未发生血管危象。术后随访4~12个月,皮瓣色泽、质地优良,弹性、功能良好,外形饱满,恢复保护性感觉。1例患者术后5个月指腹处皮瓣稍显臃肿,两点辨别觉距离为10 mm,行皮瓣修薄整形术。小腿供瓣区无明显瘢痕增生,外形良好,功能无影响。结论采用游离同侧多块小腿腓浅动脉穿支皮瓣修复手部多发创面,具有切取方便、操作简单、对供区影响小、临床效果佳的优点。

Objective To explore the effects of multiple free homologous superficial peroneal artery perforator flaps of crus for repair of multiple hand wounds. Methods From November 2017 to December 2018, eight cases with eighteen hand wounds were hospitalized in our unit. Among them, wounds were distributed in the forefinger and middle finger in four cases, wounds were distributed in the middle finger and ring finger in two cases, wounds were distributed in the forefinger, middle finger, and ring finger in one case, and wounds were distributed in the middle finger, ring finger, and little finger in one case. The area of skin defect ranged from 1.5 cm×0.8 cm to 4.0 cm×3.0 cm. There were 4 males and 4 females, aged 34-62 years. Wounds of six cases were repaired by two free superficial peroneal artery perforator flaps from homolateral crus, and those of two cases were repaired by three free superficial peroneal artery perforator flaps from homolateral crus. Superficial peroneal artery and its accompanying vein of flap were anastomosed by end to end with digital artery and palmar or dorsal subcutaneous vein of recipient site during the operation. The area of flap ranged from 2.5 cm×1.2 cm to 5.0 cm×4.0 cm. No nerve was harvested during the operation, and donor site was sutured directly. The survival of the flaps and the healing of donor sites were recorded. During follow-up, the recovery of donor and recipient sites was observed. Results All flaps survived well, donor site healed well. No vascular crisis occurred. Follow-up for 4 to 12 months showed that the appearance of flap was satisfactory with good color, texture, elasticity, and function. Protective sensation of recipient site was recovered. Five months after operation, flap of finger pulp in one case was swollen slightly with two-points discrimination of 10 mm, which received the thinning surgery. Obvious scar formation was not observed in donor site of crus. The appearance of the donor site was good without functional damage. Conclusions The application of multiple free homologous superficial peroneal artery perforator flaps of crus to repair the multiple hand wounds has advantages of easy acquisition, easy operation, little effect on donor sites, and satisfactory clinical effects.