前臂远端穿支蒂螺旋桨皮瓣修复腕关节周围皮肤软组织缺损

Soft tissue defects around wrist joints repaired with forearm distal perforator propeller flap

目的探讨前臂远端穿支蒂螺旋桨皮瓣转位修复腕关节周围缺损创面的临床疗效。方法2008年5月至2019年10月,上海交通大学医学院附属新华医院(崇明)骨科共收治腕关节周围皮肤软组织缺损患者125例,男71例,女54例,年龄16~87岁,缺损面积为3.5 cm×2.5 cm^12.0 cm×6.0 cm。根据前臂远端穿支蒂螺旋桨皮瓣的穿支血管起源、走行、分支、分布和血管网吻合的解剖学依据,结合缺损创面部位、大小、形状等特点,在患肢前臂中下段设计桡动脉远端穿支蒂螺旋桨皮瓣62例、尺动脉远端穿支蒂螺旋桨皮瓣48例、骨间背动脉远端穿支蒂螺旋桨皮瓣15例。本组患者皮瓣切取面积为4.0 cm×3.0 cm^14.0 cm×6.0 cm,供区游离前臂全厚皮片覆盖。术后综合评价患者创面修复的术后疗效、评估皮瓣肿胀程度、评估腕关节功能。结果116例患者皮瓣术后全部成活,9例皮瓣远端边缘坏死,给予换药处理。供、受区创面完全愈合。术后随访3~60个月,腕关节未见畸形,形态较佳,皮瓣色泽、弹性与周围正常皮肤接近,皮瓣两点辨距觉6~9 mm;创面愈合瘢痕较小。疗效评价:满意89例、一般36例、无不满意病例。皮瓣肿胀程度评价:早期肿胀Ⅰ度80例、Ⅱ度30例、Ⅲ度15例;后期肿胀Ⅰ度85例、Ⅱ度35例、Ⅲ度5例。腕关节功能评定:优29例、良63例、中33例、差0例,优良率为73.6%(92/125),腕关节活动和稳定性基本正常,未发现腕部疼痛影响工作和生活。结论前臂远端穿支蒂螺旋桨皮瓣转位修复腕关节周围缺损创面,疗效可靠,尤其适合中老年患者。

Objective To evaluate the clinical effect of soft tissue defects around wrist joints repaired with forearm distal perforator propeller flap.Methods The clinical data of 125 patients with defects of popliteal fossa from May 2008 to October 2019 were analyzed retrospectively,in which 71 men and 54 women were included aged from 16 to 87 years old.The sizes of soft tissue defect ranged from 3.5 cm×2.5 cm to 12.0 cm×6.0 cm.Perforator propeller flap was designed and cut to repair the defects according to their location,size and shape.62 cases of distal radial artery perforator propeller flap,48 cases of distal ulnar artery perforator propeller flap and 15 cases of distal posterior interosseous artery perforator propeller flap were included,in which the largest was 14.0 cm×6.0 cm and the smallest was 4.0 cm×3.0 cm.The donor sites were covered with free full-thickness skin grafts.Skin swelling rating in early and later stage and the color after 3 to 60 months follow-up were evaluated for the effect.Results All the flaps survived in 116 patients,though the distal edge of the flaps were necrotic in 9 cases.The incisions in donor and recipient sites were primarily healed.After 3 to 60 months follow-up,we found no deformity of wrist joints and the appearance was good;the color and elasticity were close to normal;the scar was small;two-point discrimination was 6 mm to 9 mm.The outcome was satisfactory in 89 cases,average in 36 cases and without dissatisfactory.Skin swelling rating in early stage was first degree in 80 cases,second degree in 30 cases,third degree in 15 cases;in later stage was first degree in 85 cases,second degree in 35 cases,third degree in 15 cases.Wrist function was assessed in four aspects:palmar flexion,dorsiflexion,radial deviation,and ulnar deviation.Results were excellent in 29 cases,good in 63 cases,average in 33 cases and the good rate was 73.6%.The pain of wrist did not affect the patients’daily routines and activities.Conclusions It is reliable to repair soft tissue defects around wrist joints repaired with forearm distal perforator propeller flap which is worthy of clinical use,especially in middle-aged and senile patients.