胸背动脉穿支皮瓣对手背软组织缺损的修复效果

Effect of dorsal thoracic artery perforator flap in the repair of dorsal hand soft tissue defect

目的:研究胸背动脉穿支皮瓣对手背软组织缺损的修复效果。方法:选择88例手背软组织缺损病人作为研究对象,比较病人治疗前和治疗后6个月的手功能评定量表,并分析病人的手术时间、术中出血量、住院时间、供区创面愈合时间、受区创面愈合时间、皮瓣存活率及术后并发症。结果:88例病人治疗后6个月的对指、对掌、手指内收及外展等评分及手功能评定总分高于治疗前(P<0.05~P<0.01)。88例病人的手术时间(95.32±10.59)min,术中出血量(305.21±26.87)mL,住院时间(10.53±1.65)d,供区创面愈合时间(7.26±0.95)d,受区创面愈合时间(8.47±1.16)d。88例病人中85例皮瓣存活,存活率96.59%;其余3例中,2例皮瓣发紫,经积血引流、血管扩张药治疗后改善,1例皮瓣部分坏死,二次清创及再次移植皮瓣后存活。术后发生3例血运障碍,1例血肿,1例感染,2例瘢痕增生严重,并发症发生率7.95%。结论:手背软组织缺损采取胸背动脉穿支皮瓣修复,能显著提高病人的手功能,且皮瓣存活率高,适合在临床中深入研究使用。

Objective:To study the repair effects of dorsal thoracic artery perforator flap in dorsal hand soft tissue defect.Methods:Eighty-eight patients with soft tissue defects were investigated.The hand function assessment scales of patients between before and after 6 months of treatment were compared.The patient′s operation time,intraoperative blood loss,hospital stay,donor site wound healing time,recipient site wound healing time,flap survival rate and postoperative complications were analyzed.Results:The scores of opposable fingers,opposable palms,finger adduction and abduction,and total score of hand function of 88 patients after 6 months of treatment were significantly higher than those before treatment(P<0.05 to P<0.01).The operation time,intraoperative blood loss,hospital stay,donor site wound healing time and recipient site wound healing time in 88 patients were(95.32±10.59)min,(305.21±26.87)mL,(10.53±1.65)d,(7.26±0.95)d and(8.47±1.16)d,respectively.Among 88 patients,85 skin flaps survived,and the survival rate of which was 96.59%.Two skin flaps turned purple,and improved after hemoperitoneum drainage and vasodilator treatment.One case of skin flap was partial necrosis,and survived after secondary debridement and retransplantation of the flap.There were 3 cases of blood circulation disorder,one case of hematoma,one case of infection and 2 cases of severe scar hyperplasia after operation.The incidence rate of complication was 7.95%.Conclusions:The repair of dorsal hand soft tissue defect with dorsal thoracic artery perforator flap can significantly improve the hand function of the patient,the survival rate of flap is high,which is suitable for further study and use in clinic.