以桡动脉鼻烟窝皮支为受区血管的股前外侧皮瓣修复小儿手背创面

The clinical application of anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels for repair of dorsal hand wounds in children

目的探讨以桡动脉鼻烟窝皮支为受区血管的股前外侧皮瓣修复小儿手背创面的应用效果。方法自2014年1月至2019年1月,经术前彩色多普勒超声定位,对7例手背皮肤软组织缺损患儿应用吻合桡动脉鼻烟窝皮支为受区血管的股前外侧皮瓣修复,皮瓣面积4cm×6cm-5cm×7cm,供区均直接缝合。结果术后无感染、血管危象、皮瓣坏死等,所有患儿随访6-42个月,平均23.5个月,皮瓣外形满意,质地柔软,厚度适中,弹性较好,有排汗功能,恢复部分浅感觉,虎口功能良好,无虎口狭窄等并发症发生。5例患儿术后5个月行皮瓣抽脂修整术。4例供区出现轻度瘢痕增生。结论以桡动脉鼻烟窝皮支为受区血管的股前外侧皮瓣修复小儿手背创面手术安全有效,能缩短皮瓣切取时间,降低供区损伤且不牺牲桡动脉掌背支,适合临床推广。

Objective To analyze the clinical efficacy of anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels for repair of dorsal hand wounds in children. Methods From January 2014 to January 2019, 7 cases of children with skin and soft tissue defects on the dorsum of hand ware covered by anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels by preoperative color Doppler ultrasound. The area of the flaps ranged from 4 cm×6 cm to 5 cm×7 cm. The donor sites were sutured directly. Results There were no infection, vascular crisis and necrosis of skin flaps after operation. All the children were follow-up for 6 to 42 months, with an average of 23.5 months. The skin flaps had satisfactory shape, soft texture, moderate thickness, good elasticity, good sweating function, partial superficial sensation recovery, good thumb web function and no complications such as thumb web skin contracture. Five children underwent liposuction at 5 months after operation. Mild scar hyperplasia of donor sites occurred in 4 cases. Conclusion The anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels is safe and effective in repairing the dorsal hand wound in children. It can shorten the time of skin flap removal, reduce the injury of donor site and not sacrifice the dorsal metacarpal branch of the radial artery. It is suitable for clinical promotion.