游离足底内侧动脉穿支皮瓣修复手指掌侧软组织缺损的远期随访

Long-term followed-up of free medial plantar artery perforator flap for repairing soft tissue defect of the digital palmar

目的观察游离足底内侧动脉穿支皮瓣修复手指掌侧软组织缺损的远期疗效。方法2012年1月至2015年2月,收治手指掌侧软组织缺损15例,其中8例合并指骨骨折,5例合并屈肌腱损伤,9例合并指掌侧固有动脉、指掌侧固有神经损伤,软组织缺损面积为7.0 cm×2.5 cm^2.4 cm×3.0 cm。切取以足底内侧动脉深支为血管蒂、携带隐神经终末皮支的足内侧穿支皮瓣,皮瓣的动脉与指掌侧固有动脉或指总动脉吻合,选取1条伴行静脉或浅静脉与指背静脉吻合,皮支神经与指掌侧固有神经或指总神经缝接。供区直接缝合或采用全厚皮片植皮。随访内容包括皮瓣的色泽、外形、稳定性和TPD,评价患指的功能优良率及供区有无明显瘢痕、感觉异常和异常行走步态。结果15例皮瓣全部成活,伤口均一期愈合;均获得随访,随访时间36~72个月,平均48.5个月。皮瓣色泽、厚度和正常指掌侧皮肤相近,皮瓣耐磨、稳定性好,持物有力,TPD为9~12 mm,12例末次随访于指骨间关节处出现指横纹。按中华医学会手外科学会上肢部分功能评定试用标准进行评定,优10例,良4例,可1例,优良率93.3%。供区未出现痛性瘢痕及感觉异常,足踝功能良好,行走步态正常。结论应用足底内侧动脉穿支皮瓣修复手指掌侧软组织缺损,术后远期随访皮瓣厚度、色泽、质地与手指掌侧皮肤相近,能获取良好的效果,是修复手指掌侧软组织缺损的一种较理想供区。

Objective To observe the long-term effect of repairing soft tissue defect of the digital palmar with medial plantar artery perforators flap.Methods From January,2012 to February,2015,15 cases of digital palmar soft tissue defect were selected clinically,including 8 cases with phalangeal fracture,5 cases with flexor tendon injury,and 9 cases with digital artery and nerve injury.The soft tissue defect area was 7.0 cm×2.5 cm-2.4 cm×3.0 cm.The medial pedis perforators flap with deep branch of medial plantar artery as pedicle and terminal cutaneous branch of saphenous nerve was cut out.The artery of the flap was anastomosed with the digital artery or common digital artery,1 accompanying vein or superficial vein was selected to anastomose with the dorsal digital vein,and the cutaneous nerve was anastomosed with the digital nerve or common digital nerve.The perforating point,number,source of perforating vessels and the length of vessel pedicle were observed during the operation,and the color,shape,stability and TPD of the flap were observed through long-term followed-up.The good and excellent rate of the affected finger was evaluated and whether there was obvious scar,abnormal sensation and abnormal walking gait in the donor area.Results All flaps survived and the wounds healed in one stage.All 15 patients were followed-up for 36-72 months,with an average of 48.5 months.The color and thickness of the flap were similar to that of the normal digital palmar,and the flap was wear-resistant,stable and strong in holding.The TPD was 9-12 mm.Twelve patients had transverse finger striations at the interphalangeal joint.According to the Trial Standard of the Function Evaluation of the Upper Limb of the Hand Surgery Society of Chinese Medical Association,10 cases were excellent,4 cases were good,1 case was acceptable,and the good and excellent rate was 93.3%.There was no painful scar or abnormal sensation in the donor area.The ankle and foot function was good,and the gait was normal.Conclusion The thickness,color and texture of the medial pedis perforator flap are similar to that of the palmar skin,and it is an ideal choice for repairing the palmar skin defect.