掌背动脉筋膜皮瓣与第1跖背动脉穿支皮瓣修复手指软组织并骨缺损的临床疗效

Clinical treatment of soft tissue and bone defect of finger repaired with dorsal metacarpal artery fascia flap and the first dorsal metatarsal artery perforator flap

目的探讨掌背动脉筋膜皮瓣与第1跖背动脉穿支皮瓣移植修复手指软组织或合并骨缺损的临床疗效。方法选取2017年6月-2019年7月收治的外伤所致手指近节软组织缺损合并肌腱、指骨缺损患者14例。软组织缺损面积:1.2 cm×1.6 cm~2.2 cm×4.0 cm,骨缺损长度:2.0~2.5 cm。依据患指损伤程度、损伤性质及患者意愿,分别采用:掌背动脉筋膜皮瓣加髂骨移植修复创面;第1跖背动脉穿支皮瓣及复合骨皮瓣修复创面。供区创面采用植皮或局部皮瓣转位加植皮覆盖。结果术后随访8~18个月,所有皮瓣均成活好,皮瓣供区和受区均一期愈合,不带血运髂骨骨移植愈合时间3~4个月,带血运跖背动脉骨瓣移植愈合时间2~3个月。愈后患指两点辨别觉:第1跖背动脉穿支皮瓣及复合骨皮瓣为5.0~6.0 mm,掌背动脉穿支逆行岛状皮瓣为7.5~11.5 mm。跖背动脉穿支皮瓣及复合骨皮瓣的感觉神经恢复评价为S3+级,优于掌背动脉筋膜皮瓣S2级。根据手指关节Dargan功能评价:优7例,良5例,中2例。结论游离第1跖背动脉穿支皮瓣及复合骨皮瓣修复手指皮肤软组织或合并骨、肌腱等组织缺损是一种较好的方法,植骨成活率高,可同时移植和修复肌腱、神经、血管缺损,供区隐蔽、损伤小,可最大限度恢复手指形态和功能。

Objective To investigate the clinical effect of repairing soft tissue or combined bone defect of fingers by grafting dorsal metacarpal artery fascial skin flap and first metatarsal dorsal artery perforator skin flap.Methods From June 2017 to July 2019,14 patients with proximal segment soft tissue defect or combined tendon and phalanx defect caused by traumatic injuries were selected,including 9 males and 5 females.Soft tissue defect area was 1.2 cm×1.6 cm~2.2 cm×4.0 cm,bone defect ranged 2.0~2.5 cm.According to the degree and nature of the injury and the patient's willingness,the following methods were used:The dorsal metacarpal artery fascial skin flap and iliac bone graft were used to repair the wound;The perforator branch of the first dorsal metatarsal artery skin flap and the composite osteocutaneous flap were used to repair the wound.Skin grafting or local flap transposition and skin grafting were used to cover the donor wound.The patients were followed up for 8 to 18 months.Results All the flaps survived well.The donor and recipient areas of the flaps healed in one stage.The healing time of the iliac bone grafts without blood transport was 3-4 months,and the healing time of the plantar dorsal artery bone grafts with blood transport was 2-3 months.Two points discrimination were identified:5.0~6.0 mm for the perforator branch of the first dorsal metatarsal artery and composite bone skin flap,7.5~11.5 mm for the retrograde island flap of the perforator branch of the dorsal metacarpal artery.The sensory nerve recovery rating of the perforator flap of dorsal metatarsal artery and the composite osteocutaneous flap was S3+,which was superior to the S2 grade of dorsal metatarsal artery facial flap.According to the Dargan function evaluation of finger joints,7 cases were excellent,5 cases were good,and 2 cases were fair.Conclusion The free perforating branch of the first dorsal metatarsal artery flap and the composite bone-skin flap are good methods to repair the skin and soft tissue defect combined with bone and tendon in finger.The survival rate of bone graft is high.The defect of tendon,nerve and blood vessel can be transplanted and repaired at the same time.