尺动脉穿支皮瓣接力修复上肢创面

Application of ulnar artery perforator flaps in the relay repair of upper extremity wound

目的介绍尺动脉穿支皮瓣接力修复前臂及手部创面的临床应用及疗效。方法自2019年1月至2021年3月我科收治前臂或手部创面患者共9例,创面大小为4.5 cm×5.5 cm~6.5 cm×7.3cm,仅根据术前彩超或便携式多普勒探测仪探查的创面周围尺动脉穿支血管情况,摆脱传统的上肢解剖标志及血管变异的束缚,更“自由”地设计二组尺动脉穿支皮瓣,接力修复上肢创面。二组皮瓣的面积为5.5 cm×6.5 cm~7.5 cm×8.3 cm。结果术中皮瓣缝合后张力适中,术后皮瓣存活良好,创面及手术切口均Ⅰ期愈合。随访4~15个月,平均11.2个月。皮瓣外观满意,未见明显臃肿,肤色及质地与受区周围组织相近,且将植皮可能引起的面状瘢痕转变为线性瘢痕。结论尺动脉穿支皮瓣接力修复上肢创面,未损伤前臂及手部主要血管,皮瓣外观、质地等方面均获得较为满意的结果。

ObjectiveTo introduce the clinical application and clinical efficacy of ulnar artery perforator flap for relay repair of forearm and hand wounds.MethodsFrom January 2019 to March 2021,9 patients with forearm or hand wounds were treated in our department.The size of the wound was 4.5 cm×5.5 cm to 6.5 cm×7.3 cm.Only according to the situation of the perforating vessels of the ulnar artery around the wound detected by preoperative color Doppler ultrasound or portable Doppler detector,the constraints of the traditional anatomical markers and vascular variation of the upper limb were removed,and two groups of perforating flaps of the ulnar artery were designed more freely to repair the upper limb wound.The area of the two groups of flaps was 5.5 cm×6.5 cm to 7.5 cm×8.3 cm.ResultsThe tension of the flap was moderate during the operation,the flap survived well,and the wound and incision achieved primary healing.The followup ranged from 4 to 15 months,with an average of 11.2 months.The appearance of the flap was satisfactory,no obvious swelling was found,the skin color and texture were similar to those around the recipient area,and the facial scar that may be caused by skin grafing was transformed into linear scar.Conclusion The relay repair of upper limb wound with ulnar artery perforator flap did not damage the main blood vessels of forearm and hand,and the appearance and texture of the flap were satisfactory.