使用足背静脉分叶皮瓣修复手背热压伤后软组织缺损创面

Repair of soft tissue defects after thermal crush injury of dorsal hand with dorsal pedis venous lobulated skin flap

目的探讨以足背为供区的静脉分叶皮瓣,采用静脉动脉化修复手背热压伤后遗留创面的可行性及临床疗效。方法自2018年1月至2020年1月,我科共收治6例Ⅲ~Ⅳ度热压伤致手背复杂软组织缺损患者。两处缺损5例,不规则缺损1例;缺损面积为1.0 cm×2.0 cm~3.0 cm×4.5 cm。经急诊清创后创面有肌腱等深部组织外露,二期行足背分叶静脉皮瓣,静脉动脉化并附带足背神经修复创面。供区均直接缝合。术后观察皮瓣存活情况,皮瓣色素沉着、继发性挛缩及供区愈合情况。结果本组术后均获得随访,时间为6~10个月,平均8个月。6例12叶皮瓣中有11叶顺利存活,外观平整。1叶发生部分坏死,经换药后瘢痕愈合但后期继发挛缩。2叶色素沉着。邻近关节活动度无明显受限。供区均Ⅰ期愈合。结论应用足背为供区的Y型分叶静脉皮瓣适用于两个部位或不规则形状的软组织缺损创面的修复,操作简单,是理想的修复方案之一。

Objective To investigate the feasibility and clinical efficacy of venous lobulated skin flap with dorsal foot as donor area in repairing the wound left after thermal crush injury of dorsal hand.Methods From January 2018 to January 2020,6 patients with complex soft tissue defects on the dorsal hand caused by degreeⅢtoⅣthermal crush injury were treated in our department.There were 5 cases of two defects and 1 case of irregular defect.The defect area ranged from 1.0 cm×2.0cm to 3.0 cm×4.5 cm.After emergency debridement,deep tissues such as tendons were exposed.In the second stage,the dorsal pedis lobulated venous flap was performed,and the veins were arterialized with dorsal pedis nerve to repair the wound.All the donor sites were sutured directly.The flap survival,pigmentation,secondary contracture and donor site healing were observed after operation.Results All the patients were follow-up for 6 to 10 months,with an average of 8 months.11 of the 12 lobulated flaps in 6 cases survived smoothly and had a flat appearance.Partial necrosis occurred in 1 lobe.It achieved scar healing after dressing change,but the contracture was secondary in the later stage.The pigmentation occurred in 2 lobes.The range of motion of adjacent joints was not significantly limited.All the donor sites achieved primary healing.Conclusion The Y-shaped lobulated venous flap with dorsal foot as donor area is suitable for the repair of soft tissue defects in two parts or irregular shape.The operation is simple and is one of the ideal repair schemes.