胫前动脉穿支骨皮瓣桥接再植6例缺损性断指的临床观察

Clinical observation of the bridging replantation of defective severed fingers with the anterior tibial artery perforator bone-skin flap:6 cases report

目的探讨胫前动脉穿支骨皮瓣桥接再植缺损性断指的临床效果。方法2015年3月至2019年12月,东莞长安新安医院手足显微外科应用胫前动脉穿支骨皮瓣桥接修复缺损性断指并再植6例。男5例,女1例,年龄16~55岁,平均35.8岁。冲压伤2例,绞压、热压、电锯及车祸伤各1例。其中,指骨中节缺损3例,近节缺损3例;拇、环指各1例,示、中指各2例;左手2例,右手4例。合并肌腱缺损6例,同时伴有其他指损伤3例。软组织缺损面积:5.5 cm×2.0 cm^6.0 cm×3.0 cm,指骨缺损长度:1.5~2.2 cm。皮瓣切取面积:6.5 cm×2.0 cm^7.0 cm×3.0 cm,骨瓣切取大小:1.8 cm×1.0 cm×0.8 cm^2.2 cm×1.0 cm×1.0 cm。供区创面直接缝合或皮瓣局部转移覆盖。术后制定随访计划,所有病例采用门诊、电话、微信及登门拜访相结合的方法进行随访。随访内容包括伤指术后外观、功能、生活工作情况等,采用中华医学会手外科学分会断指再植功能评定试用标准及Michigan手功能评价标准评价。结果术后骨皮瓣全部成活。随访9~24个月,皮瓣少量色素沉着,质地良好,厚薄适中,两点辨距觉为8~11 mm。小腿供区无功能影响。移植骨瓣愈合时间2.0~4.0个月,平均2.6个月。依中华医学会手外科学分会断指再植功能评定试用标准评定:优3指,良3指,优良率均为100%;采用Michigan手功能评价标准评定,6例(6指)评分71.5~91.8分,平均80.6分。结论应用胫前动脉穿支骨皮瓣桥接缺损性断指并再植,能够较大程度恢复手指外观和功能,供区损害小,是缺损性断指再植中修复骨皮缺损、恢复手指长度的有效术式。

Objective To investigate the clinical effect on bridging replantation of defective severed fingers with the anterior tibial artery perforator bone-skin flap.Methods In the Department of Hand and Foot Microsurgery of Dongguan Chang’an Xin’an Hospital,6 cases of finger defect were repaired and replanted utilizing proximal tibial artery perforator bone-skin flap from March,2015 to December,2019.There were 5 males and 1 female with an average age of 35.8 years(range,16-55 years).Among them,there were 2 cases with crush injury,1 case with wringer injury,1 case of with thermal crush injury,1 case with power saw injury and 1 case of traffic accident injury.Of which,3 cases of middle phalanx defect and 3 cases of proximal phalanx defect.1 case of thumb and ring finger,respectively,2 cases of index and middle finger.2 cases of left hand and 4 cases of right hand/side.There were 6 cases with tendon defect and 3 cases with other finger injury.Soft tissue defect area:5.5 cm×2.0 cm to 6.0 cm×3.0 cm.The length of phalangeal defect:1.5 cm to 2.2 cm.The area of flap:6.5 cm×2.0 cm to 7.0 cm×3.0 cm.The size of bone-flap:1.8 cm×1.0 cm×0.8 cm to 2.2 cm×1.0 cm×1.0 cm.The donor site was either directly sutured or covered by transposing local flap.Follow-up plan was setafter operation.All patients were followed-up by outpatient service telephone,wechat and home visit etc.The dimensions of follow-up included the appearance,function,living and working conditions regarding the injured finger after operation.The evaluation was carried out according to the evaluation criteria of the society of hand surgery,Chinese Medical Association and the Michigan hand function evaluation criteria.Results All the flaps survived.The flaps were followed-up for 9 to 24 months,with a small amount of pigmentation,good texture,moderate thickness and the two-point discrimination of the flaps ranged from 8 to 11 mm.There was no functional effect on the lower leg.The healing time of transplanted bone flaps ranged from 2.0 to 4.0 months,with an average of 2.6 months.According to the evaluation criteria of upper limb function of Hand Surgery Society of Chinese Medical Association,the results were as follows:excellent 3 fingers,good 3 finger,excellent rate was 100%.According to Michigan Hand Function Evaluation Criteria,6 fingers scored from 71.5 to 91.8 points,with an average of 80.6 points.Conclusions Using the anterior tibial artery perforator bone-skin flap to bridge the defect and replantation can restore the appearance and function of the fingers to a large extent,with little damage to the donor site.It is an effective surgical method to repair bone-skin defects and restore the length in the replantation of defective severed fingers.