游离上臂外侧穿支皮瓣修复手部中、小面积皮肤缺损的临床疗效

Clinical effect of free upper arm lateral perforator flap for repair the middle and small skin defects of hand

目的探讨应用游离上臂外侧穿支皮瓣修复手部中、小面积皮肤软组织缺损的临床疗效。方法回顾性分析自2012年4月至2018年5月内蒙古医科大学第三附属医院手足踝外科采用上臂外侧穿支皮瓣修复伴有深部组织外露的手部软组织缺损19例,其中男17例,女2例;平均年龄(27±4)(23~45)岁,左侧8例,右侧11例;致伤原因:机器挤压伤12例,电击伤、烧伤6例,外伤瘢痕挛缩1例;修复部位:示指7例,中指3例,手指并手背6例,手掌、背侧2例,虎口区1例;合并掌骨、指骨骨折10例,伸、屈肌腱断裂12例,急诊予清创、骨折复位克氏针内固定,断裂肌腱断端吻合,缺损面积:2.0 cm×4.0 cm~5.0 cm×9.5 cm。6~9 d后,予皮瓣修复,皮瓣大小:3.5 cm×5.5 cm~7.0 cm×11.0 cm。术后密切观察皮瓣颜色、温度、肿胀及毛细血管返流情况,予常规抗炎、抗凝、解痉治疗、石膏固定3周,开始功能康复,并定期随访。结果本组19例皮瓣全部成活,15例获得随访,平均随访时间6个月(3~17个月),按照中华医学会手外科学会上肢部分功能评定试用标准:优13例,良2例,S3+9例,S35例,S21例,两点辨别觉6~13 mm,皮瓣外观、质地良好。供区除1例植皮外均直接缝合,无明显并发症,肢体活动无影响。结论上臂外侧穿支皮瓣血管解剖恒定,血供可靠,操作简便,皮瓣厚薄适中,感觉恢复良好,外形较美观,供区创伤小,是修复手部中、小面积软组织缺损(﹤15.0 cm)的一种有效可行的方法。

Objective To explore the clinical effects of repairing middle and small skin defects of hand by using free upper arm lateral perforator flap.Methods From April 2012 to May 2018,19 cases of hand soft tissue defects with deep tissue exposure enrolled in Department of Hand,Foot and Ankle Surgery,Third Clinical Medical College of Inner Morgolia Medical University were repaired with free upper arm lateral perforator flap.There were 17 males and 2 females with a mean age of(27±4)years(range,23-45 years),8 cases on the left side and 11 cases on the right side;The causes included 12 cases of machine crush injury,6 cases of electric shock and burn,and 1 case of traumatic scar contracture.The repaired area included 7 cases of index finger,3 cases of middle finger,6 cases of fingers and back of the hand,2 cases of palm and dorsal side,1 case of Hukou area;combined metacarpal and phalangeal fractures in 10 cases,extensor and flexor tendon ruptures in 12 cases,and emergency debridement and fracture reduction and Kirschner wire internal fixation were performed with broken tendon anastomosis,with a defect area of 2.0 cm×4.0 cm to 5.0 cm×9.5 cm.After 6-9 days,flap repair was performed,and the flap size ranged from 3.5 cm×5.5 cm to 7.0 cm×11.0 cm.The color,temperature,swelling and capillary reflux of the flap were closely observed after operation.Routine,anticoagulant,antispasmodic treatment and plaster immobilization were given for 3 weeks.Functional rehabilitation was started and regular follow-up was performed.Results All 19 skin flaps in this group survived,and 15 patients were followed up for 3-17 months(mean,6 months).According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association:the results were excellent in 13 cases,good in 2 cases,S3+in 9 cases,S3 in 5 cases,S2 in 1 cases.The two-point discrimination was 6-13 mm.The skin flap of the wound repair area had good texture and ideal appearance.The donor area was directly sutured except for one case of skin grafting,with no significant complications and no effect on limb movement.Conclusions The lateral arm free perforator flap has constant vessels anatomy,reliable blood supply,easy operation,moderate thickness of the flap,good recovery,beautiful appearance,and minor trauma to the donor area.It is an effective and feasible method to repair moderate and small areas soft tissue defects(﹤15.0 cm)of the hand.