Flow-through腓浅动脉皮瓣修复手指伴指掌侧固有动脉缺损创面

Flow-through superficial peroneal artery flap in repair of digit defect with proper palmar digital artery

目的总结游离Flow-through腓浅动脉皮瓣修复手指伴指掌侧固有动脉缺损创面的手术方法及临床疗效。方法2015年6月至2019年12月,对7例7指伴指掌侧固有动脉缺损创面的患者,应用游离Flow-through腓浅动脉皮瓣修复手指创面,同时桥接修复指掌侧固有动脉。其中拇指2例2指,示指3例3指,中指2例2指。手指缺损创面面积为2.5 cm×3.0 cm~5.0 cm×7.0 cm;指掌侧固有动脉缺损为1.0~3.0 cm。皮瓣切取面积为3.0 cm×3.5 cm~5.5 cm×8.0 cm,皮瓣供区直接缝合或植皮覆盖。术后予预防感染、抗痉挛、抗凝血、镇痛、补液等支持治疗,卧床制动1周。每月定期随访,在医师指导下行功能锻炼。结果7例7指皮瓣及指体全部成活,未发生血管危象,伤口一期愈合。术后随访6~18个月,平均8个月,皮瓣色泽、质地好,弹性良好,外形饱满,无明显臃肿,术后6个月均恢复保护性感觉;手指无明显肿胀、萎缩,皮肤温度正常,根据中华医学会手外科学会上肢部分功能评定试用标准评定指体功能,优3例,良4例;小腿供区无明显瘢痕增生,外形良好,功能无影响。结论游离Flow-through腓浅动脉皮瓣修复手指伴指掌侧固有动脉缺损创面,手术操作简单,皮瓣血供可靠,皮瓣外形满意,并能同时修复指掌侧固有动脉缺损,手指血供、外形、功能恢复良好,供区无明显影响,是一种较理想的修复方法。

Objective To explore the surgical procedure and clinical effect of the free Flow-through superficial peroneal artery flap for repairing the digit injury with defect of proper palmar digital artery.Methods From June,2015 to December,2019,free Flow-through superficial peroneal artery flap was used to repair the digit injury and to bridge the proper digital artery in 7 digits of 7 patients.There were 2 thumbs,3 index fingers and 2 middle fingers.The size of defects on digits ranged from 2.5 cm×3.0 cm to 5.0 cm×7.0 cm.The defects of digit proper artery were 1.0 to 3.0 cm.The size of flaps was from 3.0 cm×3.5 cm to 5.5 cm×8.0 cm.The donor areas of the flap were di-recdy sutured or covered with skin graft.Postoperative supportive treatments were given,such as infection prevention,antispasmodic,anticoagulant,analgesia and fluid infusion.The patients were kept in bed for 1 week after surgery.Monthly follow-up review were conducted and the patients were kept with the rehabilitation exercises under medical guidance.Results All the patients entered postoperative followed-up for 6 to 18 months,with an average of 8 months.All flaps survived without any adverse event.All wounds achieved stage-one-healing.The flaps appeared in good colour,texture,elasticity and the plumps of the digit without obvious bloating.There was no obvious swelling and atrophy of the digits.The skin temperature was normal.According to the Standard for Evaluation of Upper Limb Function by the Hand Surgery Society of Chinese Medical Association,3 digits were excellent and 4 were good.There was no obvious scar at the donor site of shank.The donor site had a good appearance and the limb function was not affected.Conclusion The free Flow-through superficial peroneal artery flap is an ideal material to repair the defect of digit with the defect of proper digital artery.It has the advantages of simple surgical procedure,reliable blood supply and satisfactory appearance.The defect of proper digit artery can be repaired at the same time of the surgical procedure.The blood supply,appearance and function of the digits could be well recovered and the donor site is not affected.