游离骨间后动脉穿支皮瓣在小面积手部皮肤软组织缺损中的应用

Application of free interosseous posterior artery perforator flap in small hand defects

目的探讨游离骨间后动脉穿支皮瓣在小面积手部皮肤软组织缺损中的应用效果。方法回顾性分析2019年3月至2020年8月遵义医科大学第二附属医院烧伤整形外科采用游离骨间后动脉穿支皮瓣治疗的小面积手部皮肤软组织缺损病例资料。术中根据缺损创面大小设计游离骨间后动脉穿支皮瓣移植修复创面,骨间后动脉穿支与指固有动脉、指总动脉吻合,供区直接缝合。术后观察皮瓣成活情况,随访皮瓣修复效果、手部功能及并发症情况。结果纳入21例患者,男15例,女6例,年龄23~61岁,平均46岁。致伤原因:重物砸伤7例,机器绞伤11例,烧烫伤3例;缺损部位:掌侧共8例,背侧共13例,缺损范围为1.5 cm×2.0 cm~3.0 cm×9.0 cm,伴有肌腱及骨外露,皮瓣大小为2.0 cm×2.0 cm~3.5 cm×9.0 cm,其中携带肌腱重建手指伸指功能1例,携带神经移植修复手掌侧创面2例,分叶皮瓣游离移植4例,余14例均为单叶游离皮瓣。术后皮瓣均未发生动静脉危象,21例患者皮瓣全部成活,皮瓣未出现血运障碍。随访6~12个月,皮瓣成活良好,质地与周围皮肤相近,手部功能活动无受限,携带神经移植者皮瓣两点辨距觉10~12 mm,前臂供区无严重并发症,遗留线状瘢痕。结论骨间后动脉穿支皮瓣应用灵活,可以游离分叶移植同时修复邻近2个小创面,可以携带皮神经游离移植修复手掌侧创面,该皮瓣是修复手部小创面的理想皮瓣之一。

Objective To evaluate the effect of free interosseous posterior artery perforator flap in small hand defects.Methods We retrospectively analyzed the case data of small hand skin and soft tissue defects treated with free interosseous posterior arterial perforator flaps from March 2019 to August 2020 in the Department of Burn Plastic Surgery,the Second Affiliated Hospital of Zunyi Medical University.According to the size of the defect during the operation,we designed free interosseous posterior artery perforator flap transplantation to repair wounds,and the perforating branch of the posterior interosseous artery is anastomosed with the proper digital artery and the common digital artery.The donor valve area is sutured directly.After the operation,the survival of the flaps was observed,and the repair effect of the flaps,hand function and complications were followed up.Results Twenty-one cases were included,among whom there were 15 males and 6 females with a median age of 46 years(range,23-61years).There were several causes of injury:7 cases of heavy object injuries,11 of machine strangulation,3 of burns and scalds.For 8 cases,the defect sites were on the palms and 13 on the dorsal sites.The defect size ranged from 1.5 cm×2.0 cm to 3.0 cm×9.0 cm with exposed tendons and bones.The flap size ranged from 2.0 cm×2.0 cm to 3.5 cm×9.0 cm.Among them,compound tissue transplantation with tendon was used to reconstruct finger extension function in 1 case while tissue transplantation with nerve was used to repair the palmar wounds in 2 cases.The bilobed flaps were used in 4 cases,and the remaining 14 cases were single leaf free skin flaps.No arteriovenous crisis occurred in the flaps after the operation.All flaps of 21 patients survived,and there was no blood supply disorder in the flaps.After 6-12 months of follow-up,the texture and color of the flap were similar to adjacent skin,and unrestricted hand function was unrestricted.The two-point discernibility of the skin flap for patients with nerve grafts was 10-12 mm,serious complication in the donor sites,but the forearm donor area with linear scars.Conclusions The application of interosseous posterior artery perforator flap is flexible.It can repair two adjacent small wounds at the same time with free bilobed transplantation,and can carry free cutaneous nerve transplantation to repair the palm side wound.This flap is one of the ideal flaps for repairing small defects on the hand.