第2掌背动脉穿支皮瓣接力第1掌背动脉尺侧支皮瓣修复拇指软组织缺损

Repair of soft tissue defect of thumb with the second dorsal metacarpal artery perforator flap relay the first dorsal metacarpal artery ulnar branch flap

目的探讨第2掌背动脉穿支皮瓣接力第1掌背动脉尺侧支皮瓣修复拇指软组织缺损的临床疗效。方法2019年12月至2020年10月,毕节市第一人民医院整形手外科共收治拇指软组织缺损伴骨或肌腱外露创面7例,创面面积1.5cm×2.0cm~2.5cm×3.0cm,根据拇指创面设计第1掌背动脉尺侧支皮瓣修复,皮瓣面积2.0cm×2.5cm~2.5cm×3.5cm,根据第1掌背动脉尺侧支皮瓣供区创面设计第2掌背动脉穿支皮瓣修复,皮瓣面积2.0cm×2.5cm~3.0cm×4.0cm,第2掌背动脉穿支皮瓣供区直接缝合。患者出院后门诊随访,采用英国医学研究会感觉评定标准评估皮瓣感觉,采用关节总活动度(TAM)评估拇指及示指功能。结果本组7例第1掌背动脉尺侧支皮瓣,5例顺利成活,2例部分坏死,经换药创面愈合,7例第2掌背动脉穿支皮瓣全部成活。随访6~15个月,平均9.0个月,第1掌背动脉尺侧支皮瓣外形、色泽、质地与拇指皮肤接近,皮瓣感觉1例S4(存在异位感觉定位现象),3例S 3+(2例存在异位感觉定位现象),2例S3,1例S2。第2掌背动脉穿支皮瓣外形、色泽、质地与示指皮肤接近,皮瓣感觉1例S3,3例S2,3例S1。拇指TAM评定,优4例,良3例,优良率100%。示指TAM评定,优6例,良1例,优良率100%。结论第2掌背动脉穿支皮瓣接力第1掌背动脉尺侧支皮瓣修复拇指创面,拇、示指外形及功能恢复满意,但该术式对手背创伤较大,不建议临床上作为拇指创面修复的常规术式。

Objective To investigate the clinical effect of the second dorsal metacarpal artery perforator flap relay the first dorsal metacarpal artery ulnar branch flap in repairing thumb soft tissue defect.Methods From December,2019 to October,2020,seven cases of thumb soft tissue defect with bone or tendon exposure were treated at the Department of Plastic Hand Surgery,the First People's Hospital of Bijie City.The wound area was 1.5 cm×2.0 cm~2.5 cm×3.0 cm.According to the thumb wound,the first dorsal metacarpal artery ulnar branch flap was designed to repair the thumb wound.The flap area was 2.0 cm×2.5 cm~2.5 cm×3.5 cm.According to the donor site of the first dorsal metacarpal artery flap,the second dorsal metacarpal artery perforator flap was designed to repair the donor site of the first dorsal metacarpal artery flap.The flap area was 2.0 cm×2.5 cm~3.0 cm×4.0 cm.The donor site of the second dorsal metacarpal artery perforator flap was sutured directly.After discharge,patients were followed up in outpatient department.The sensation of flap was evaluated by British Medical Research Council Sensory Scale,and the function of thumb and index finger was evaluated by total active movement(TAM).Results In this group of 7 cases of the first dorsal metacarpal artery ulnar branch flap,five survived successfully and 2 partially necrotized.The second dorsal metacarpal artery perforator flaps survived in 7 cases.The followed-up time was 6-15 months(average 9.0 months).The appearance,color and texture of the first dorsal metacarpal artery ulnar branch flap were similar to those of thumb skin.The sensation of flaps recovered to S4 in 1 case(ectopic sensory positioning),S 3+in 3 cases(2 cases of ectopic sensory positioning),S3 in 2 cases and S2 in 1 case.The appearance,color and texture of the second dorsal metacarpal artery perforator flap were similar to those of the index finger skin.The sensation of flaps recovered to S3 in 1 case,S2 in 3 cases and S1 in 3 cases.Thumb TAM assessment showed that 4 cases were excellent and 3 cases were good and the excellent rate was 100%.Index finger TAM assessment indicated that 6 cases were excellent and 1 case was good and the excellent rate was 100%.Conclusion The second dorsal metacarpal artery perforator flap could relay the first dorsal metacarpal artery ulnar branch flap to repair the thumb wound.The appearance and function of thumb and index finger are satisfactory.However,this operation has a large hand back injury.Thus,it is not recommended as a routine operation for thumb wound repair.