足底内侧Flow-through静脉皮瓣游离移植一期修复儿童指动脉缺损创面

Free transplantation of medial plantar Flow-through venous flap for primary repairing children’s finger wounds with digital artery defect

目的探讨足底内侧Flow-through静脉皮瓣游离移植一期修复儿童指动脉缺损创面的可行性和临床效果。方法2016年7月—2020年10月,采用足底内侧Flow-through静脉皮瓣游离移植一期修复儿童指动脉缺损创面9例。男6例,女3例;年龄4~13岁,平均6.8岁。致伤原因:重物压砸伤5例,绞伤4例。其中示指3例,中指3例,环指2例,小指1例。创面范围为1.8 cm×1.5 cm~4.0 cm×2.5 cm。受伤至手术时间1.3~8.6 h,平均4.8 h。皮瓣切取范围为2.0 cm×1.6 cm~4.2 cm×2.6 cm。9例皮瓣倒置后均采用静脉桥接指动脉同时修复创面。足部供区直接缝合4例,全厚皮片植皮修复5例。结果术后皮瓣全部成活,手部创面均Ⅰ期愈合;足部供区创面Ⅰ期愈合8例,1例植皮边缘部分坏死,经换药后愈合。9例患儿均获随访,随访时间3~24个月,平均9个月。皮瓣色泽、质地与周围正常皮肤相似,恢复保护性感觉,皮瓣两点辨别觉为7~10 mm,平均8 mm。末次随访时,按中华医学会手外科学会上肢部分功能评定试用标准,手指功能达优5例、良4例。足部供区无溃疡形成及瘢痕增生,不影响行走。结论应用足底内侧Flow-through静脉皮瓣游离移植一期修复儿童指动脉缺损创面具有皮瓣切取简单,皮瓣菲薄,色泽、质地与手部皮肤相近,供区隐蔽等优势,是理想修复方法。

Objective To explore the feasibility and effectiveness of free transplantation of medial plantar Flowthrough venous flap for primary repairing children’s finger wounds with digital artery defect.Methods Between July 2016 and October 2020,9 children who suffered finger wounds with digital artery defect were primary repaired with free transplantation of medial plantar Flow-through venous flap.There were 6 boys and 3 girls,with an average age of 6.8 years(range,4-13 years).The defects were caused by heavy weight puncture injury in 5 cases and strangulation injury in 4 cases.Among them,there were 3 cases of index finger wounds,3 cases of middle finger wounds,2 cases of ring finger wounds,and 1 case of little finger wounds.The wound area ranged from 1.8 cm×1.5 cm to 4.0 cm×2.5 cm.The time from injury to operation was 1.3-8.6 hours,with an average of 4.8 hours.The flap area ranged from 2.0 cm×1.6 cm to 4.2 cm×2.6 cm.After the flaps were inverted,the veins were used to bridge the finger arteries while repairing the wounds.The donor site of the foot was sutured directly in 4 cases,and repaired with full-thickness skin grafts in 5 cases.Results All flaps survived,and hand wounds healed by first intention;8 cases of foot donor site wounds healed by first intention,and 1 case had partial necrosis in the marginal area of the skin graft,which healed after dressing change.All 9 children were followed up 3-24 months,with an average of 9 months.The color and texture of the flap were similar to those of the surrounding normal skin,and the protective feeling was restored.The two-point discrimination of the flap was 7-10 mm,with an average of 8 mm.At last follow-up,according to the upper limb function evaluation standard of Hand Surgery Society of Chinese Medical Association,the finger function was excellent in 5 cases and good in 4 cases.There was no ulcer formation and scar hyperplasia in the foot donor site,which did not affect walking.Conclusion The free transplantation of medial plantar Flow-through venous flap is an ideal repair method for repairing children’s finger wounds with digital artery defect.It has the advantages of simple flap extraction,thin flap,similar color and texture to the skin of the hand,and concealed donor site.