带掌长肌腱的动脉化Flow-through静脉皮瓣修复指背侧复合组织缺损

Application of arterialised Flow-through venous flap with palmaris longus tendon in repair of dorsal digit composite tissue defect

目的探讨带掌长肌腱的动脉化Flow-through静脉皮瓣修复指背侧复合组织缺损的疗效。方法自2010年3月至2018年12月,应用带掌长肌腱的动脉化Flow-through静脉皮瓣修复指背侧复合组织缺损23例23指,男17例17指,女6例6指,年龄23~53(平均37.2)岁。致伤原因:绞伤15例,电刨伤5例,热压伤3例。均为指背侧复合组织缺损,其中拇指1例,示指11例,中指9例,环指2例。均为软组织及肌腱缺损,软组织缺损面积2.0 cm×1.8 cm~4.2 cm×2.6 cm,肌腱缺损长度1.6~2.6 cm;其中1例伴有伸肌腱终腱止点及中央腱止点缺损,5例伴有终腱止点缺损。3例为急诊手术修复,20例为亚急诊手术修复。供区直接缝合。术后门诊随访皮瓣的外形、色泽、质地、感觉、指体功能恢复情况和供区外形。结果术后随访8~23个月,平均11个月。皮瓣外形无臃肿,质地柔软,有轻度色素沉着,保护性感觉恢复;指近侧及远侧指骨间关节总活动度145°~170°,平均162.6°,按Strickland手功能评定方法评定,结果全为优。结论带掌长肌腱的动脉化Flow-through静脉皮瓣是修复指背侧复合组织缺损的一种较理想修复方法。

Objective To investigate the effect of arterialised Flow-through venous flap with palmaris longus tendon in repairing dorsal digit composite tissue defect.Methods From March,2010 to December,2018,23 cases(23 digits)of dorsal digit composite tissue defect were repaired with arterialised Flow-through venous flap with palmaris longus tendon.There were 17 males and 6 females aged between 23 to 53(average,37.2)years old.Causes of injury:15 cases of strangulation,5 of electric plane and 3 of thermal crush.Number of injured digit were 1 thumb,11 index fingers,9 middle fingers and 2 ring fingers.All of the injured digits had skin and extensor tendon defects with an area of 2.0 cm×1.8 cm-4.2 cm×2.6 cm,and the length of extensor tendon defect was 1.6-2.6 cm.One case had terminal and central tendon insertion defects and 5 suffered with terminal tendon insertion defect.Three cases were repaired by emergency surgery,and 20 were repaired by sub-emergency surgery.All donor sites were directly sutured.The shape,colour,texture,sensation,recovery of digit function and donor site appearance were followed-up at outpatient clinic.Results The patients were followed-up for 8 to 23(average,11)months.The flap was soft,with mild pigmentation and recovery of protective sensation.The range of motion of the proximal and distal interphalangeal joints was 145°-170°(average,162.6°).According to Strickland hand function evaluation method,the results were excellent.Conclusion The arterialised Flow-through venous flap with palmaris longus tendon is an ideal method in repair of the dorsal digit composite tissue defect.