以指蹼交通支为蒂的掌背动脉皮瓣修复指背中远节皮肤缺损

Repairing of skin defect of middle and distal segment of finger back by dorsal metacarpal artery flap pedicled with communicating branch of finger web

目的探讨应用以指蹼交通支为蒂的掌背动脉皮瓣修复指背中远节皮肤缺损的方法和临床效果。方法选取2019年8月至2021年1月在西安医学院附属宝鸡医院骨外科二病区就诊的9例因外伤导致的指背中远节皮肤缺损患者采用逆行掌背动脉皮瓣修复,延长并游离掌背动脉的指蹼交通支至指固有动脉,以指蹼交通支和指掌侧总动脉或指固有动脉交汇处为旋转点蒂旋转,修复手指背中远节皮肤缺损。结果术后9例皮瓣全部成活,伤口均Ⅰ期愈合,随访时间为3~6个月,皮瓣外形及手指功能恢复满意。术后患指关节伸屈功能根据总主动活动度(TAM)系统评定法评定,优8例,良1例。结论采用指蹼交通支为蒂的掌背动脉皮瓣修复指背中远节皮肤缺损,延长了皮瓣蒂部,降低皮瓣张力,手术操作简单,是一种修复指背缺损的较好方法。

Objective To explore the method and clinical effect of repairing skin defect of middle and distal segment of finger back by dorsal metacarpal artery flap pedicled with communicating branch of finger web.Methods A total of 9 patients with skin defects of the middle and distal dorsal segment of the finger caused by trauma,treated with reverse dorsal metacarpal artery flap in the Second Ward of Orthopedic Surgery,Baoji Hospital Affiliated to Xi'an Medical College from August 2019 to January 2021,were selected as the research subjects.The communicating branch of the dorsal metacarpal artery was extended and free to the proper digital artery.The intersection of the communicating branch of the dorsal metacarpal artery and the common palmar digital artery or the proper digital artery was used as the rotation point to repair the skin defects of the middle and distal dorsal segment of the finger.Results After the operation,all the skin flaps survived,and the wounds healed by first intention.The average follow-up time of the patients was 3 to 6 months,and the shape of the flap and the function of the fingers recovered satisfactorily.The postoperative extension and flexion function of the affected knuckles was evaluated according to the total active motion(TAM)system evaluation method:8 cases were excellent and 1 case was good.Conclusion Dorsal metacarpal artery flap pedicled with the communicating branch of the finger web is a good method to repair the skin defect of the middle and distal segment of the finger back.