Flow-through穿支皮瓣在复杂性断指患者再植中的应用效果

Application effect of Flow-through perforator flap in replantation of patients with complicated amputated fingers

目的观察腕掌侧桡动脉掌浅支Flow-through穿支皮瓣在伴有环形皮肤软组织缺损的复杂性断指患者再植中的临床疗效。方法回顾性分析2016年10月至2018年5月接受断指再植术的患者8例,男6例,女2例,年龄17~44岁,平均(31.3±8.4)岁;右手5例,左手3例;致伤原因为冲压伤5例,机器绞勒伤2例,热压伤1例;受伤指为示指3例,中指3例,环指1例,小指1例;所有患者患指均有骨、肌腱、肌肉、神经、血管等组织外露并伴有环状皮肤软组织缺损,缺损范围为2.1 cm×0.9 cm^6.2 cm×2.2 cm;受伤至手术时间1.5~8.5 h,中位时间3 h。所有患者均采用腕部掌侧桡动脉掌浅支Flow-through穿支皮瓣移植重建断指环状皮肤软组织缺损修复治疗,术后观察供区愈合、皮瓣成活情况及手功能恢复情况。结果所有患者供区创面均达到了Ⅰ期愈合标准。1例皮瓣出现边缘表皮坏死,经换药后愈合;1例皮瓣出现肿胀和水疱,手术后1周自行缓解;其他患者的受区皮瓣、断指均成活,且创面达到Ⅰ期愈合,外观良好。术后9个月所有患指外观良好、瘢痕较小,在TAM评价中优5例,良2例,可1例。结论腕掌侧桡动脉掌浅支Flow-through穿支皮瓣在伴有环形皮肤软组织缺损的复杂性断指患者再植中皮瓣成活率高,手指功能恢复较好,供区创面愈合好,整体效果较为理想。

Objective To observe the clinical effect of Flow-through perforator flaps of the superficial palmar radial artery of the carpal palmar branch in the replantation of patients with complicated amputated fingers with circular skin and soft tissue defects.Methods A retrospective analysis of 8 patients who underwent the replantation of complicated amputated fingers from October 2016 to May 2018,including 6 males and 2 females,age range was 17-44 years,with an average age of(31.3±8.4)years,5 in the right hand and 3 in the left hand,5 with punching injury,2 with mechanical strangulation injury and 1 with thermal compression injury,3 in the index finger,3 in the middle finger,1 in the ring finger and 1 in the small finger.All bones,tendons,muscles,nerves,blood vessels and other tissues were exposed and accompanied by circular skin and soft tissue defects,the defect range was 2.1 cm×0.9 cm-6.2 cm×2.2 cm;the time from injury to surgery was between 1.5-8.5 h,the median time was 3 h.All patients were treated with flow-through percutaneous branch flaps of the palmar radial artery of the wrist for reconstruction of the ring finger skin and soft tissue defects.The donor site healing,skin flap survival,and hand function recovery were observed after surgery.Results The donor site wounds of all patients met the stage I healing criteria.One patient's flap showed necrosis of the marginal epidermis,and healed after dressing change.One patient's flap showed swelling and blisters,which resolved one week after surgery.The remaining patients'flaps and broken fingers all survived,and the wound reached the standard of stage I healing with good appearance.After 9 months of surgery,all patients had good-looking fingers and small scars.In the TAM evaluation,the effect was significant in 5 cases,good in 2 cases,and average in 1 case.Conclusion Flow-through perforator flaps of the radial branch of the carpal volar radial artery has high flap survival rate,good finger function recovery,good healing of the donor site wound,and ideal overall results in complex finger replantation with circular skin and soft tissue defects.