桡动脉掌浅支嵌合骨皮瓣游离移植重建复合组织缺损的指体

Chimeric bone flap pedicled with superficial palmar branch of radial artery in reconstruction of fingers with composite tissue defect

目的探讨以桡动脉掌浅支为蒂的嵌合骨皮瓣游离移植重建部分手指指体的临床疗效。方法2018年7月-2020年1月,应用桡动脉掌浅支为蒂的嵌合骨皮瓣游离转移重建手指复合组织缺损9例,术中切取以桡动脉掌浅支为蒂的腕横纹皮瓣和桡骨远端骨瓣,皮瓣面积2.0 cm×4.0 cm~3.0 cm×6.5 cm,骨瓣长度1.5~2.5 cm。术后半年内每月于门诊随访,半年后通过微信随访。结果本组9例术后均获随访,随访时间6~24个月,嵌合骨皮瓣均成活良好;骨瓣平均愈合时间1.7个月;重建手指长度平均2.4(1.8~3.0)cm;患指外观恢复良好;供区瘢痕轻微;术后6个月皮瓣TPD平均为6.6(5.3~8.6)mm,末次随访按中华医学会手外科学会上肢部分功能评定拇、手指再造功能评定试用标准评定患指功能:优7例,良1例,中1例。结论以桡动脉掌浅支为蒂的游离嵌合骨皮瓣,可同时重建手指软组织和骨缺损,恢复患指功能及长度,改善患指功能及外观,供区损伤较小,是手指指体重建的简便方法。

Objective To investigate the clinical effect of free chimeric bone flap pedicled with superficial palmar branch of radial artery in reconstruction of partial finger with composite tissue defect.Methods From July,2018 to January,2020,9 cases of compound tissue defect of fingers were reconstructed by free transfer of chimeric bone flap pedicled with superficial palmar branch of radial artery.The wrist transverse striated flap and distal radius bone flap pedicled with superficial palmar branch of radial artery were harvested in operations.The size of flap were 2.0 cm×4.0 cm-3.0 cm×6.5 cm,and the length of bone flaps were 1.5-2.5 cm.All patients entered monthly follow-up by clinic visit in 6 months after the surgery,and thereafter by WeChat interviews.Results All of the 9 chimeric bone flaps survived well.The average healing time of bone flap was 1.7 months,and the average length of reconstructed finger was 2.4(1.8-3.0)cm;The appearance of the affected fingers restored well,the scars of the donor sites were mild,and average of the TPD of the flaps was 6.6(5.3-8.6)mm at 6 months after the surgery.The function of the affected finger was evaluated according to the Trial Standard of the Upper Limb Function Evaluation proposed by the Hand Surgery Society of the Chinese Medical Association:excellent in 7 cases,good in 1 case and medium in 1 case.Conclusion Free chimeric bone flap pedicled with superficial palmar branch of radial artery can be used in reconstruction of the soft tissue and bone defects of fingers at the same time.It restores the functional length of fingers,improves the function and appearance of fingers,with less damage to the donor site.It is a simple method for reconstruction of finger defects.