足底内侧动脉皮瓣修复拇指和手指指腹缺损十例

Pulp defect of thumb and finger repaired by the medial plantar artery flap:Report of 10 cases

目的探讨足底内侧动脉浅支为蒂的游离足底内侧动脉皮瓣(MPAF)修复拇指和手指指腹创面的疗效。方法 2020年11月-2022年1月, 西南医科大学附属中医医院手外科采用足底内侧动脉浅支为蒂的游离MPAF修复10例(10指)拇、手指指腹缺损, 其中切割伤3例, 电锯伤2例, 挤压伤2例, 撕脱伤3例。损伤指别:示指4指, 拇指3指, 中指2指, 环指1指。入院后行多普勒超声检查了解足底内侧动脉走行情况, 急诊行游离MPAF修复指腹缺损, 供区取皮植皮覆盖。清创后软组织缺损面积2.0 cm×2.5 cm~3.0 cm×4.5 cm, 皮瓣切取面积2.5 cm×3.0 cm~3.5 cm×5.0 cm。由同一组医生进行门诊随访, 评估术后效果, 并参照中华医学会手外科学会上肢部分功能评定试用标准评定功能恢复情况。结果 10例以足底内侧动脉浅支为蒂的游离MPAF全部成活, 移植后皮瓣的色泽、质地、厚薄与指腹匹配, 外观逼真, 不需要二期行皮瓣修薄, 其中2例皮瓣远端出现水疱, 抽液换药后愈合。本组患者均获得随访, 随访时间3~18个月, 皮瓣TPD为4~7 mm;供区全厚皮片移植成活良好;末次随访时根据中华医学会手外科学会上肢部分功能评定试用标准评定手功能, 结果优8例, 良2例。结论足底内侧动脉浅支为蒂的游离MPAF修复拇、手指指腹缺损, 血供可靠, 质地优良, 外形美观。

Objective To investigate the effect of using the free medial planar artery flap(MPAF)pedicled by the superficial branch of the medial plantar artery in repair of pulp defect of thumb and finger.Methods Ten patients with pulp defect of thumb and finger were repaired with MPAF of foot in the Department of Hand Surgery of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from November 2020 to January 2022.There were 3 cases of cutting injury,2 cases of chainsaw injury,2 cases of extrusion injury and 3 cases of avulsion injury.Digits injuried:4 index fingers,3 thumbs,2 middle fingers,and 1 ring finger.After admission,Doppler ultrasound was performed to understand the running course of medial plantar artery.Emergency surgeries were performed to repair the pulp defects of thumb and finger with free MPAF,and donor sites were repaired by skin grafting.The area of soft tissue defects was 2.0 cm×2.5 cm-3.0 cm×4.5 cm,and the size of flap was 2.5 cm×3.0 cm-3.5 cm×5.0 cm after debridement.Postoperative effect was assessed over the follow-up at outpatient clinics by same group of surgeons.Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results All 10 free MPAFs pedicled by the superficial branch of medial plantar artery survived.After the transfer,the colour,texture and thickness of the flaps were matched with the digit with pulps realistic appearance.Secondary flap thinning surgery was not required.Two cases had blisters at the distal end of the flap,and healed after fluid extraction and dressing change.All patients had 3 to 18 months of follow-up.The TPD of the flap was 4-7 mm.The skin grafts in the donor sites survived well.At the last follow-up,the upper limb function was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,with the results of 8 cases in excellent and 2 in good.Conclusion Free MPAF pedicled by the superficial branch of medial plantar artery can repair the pulp defect of thumb and finger with reliable blood supply,excellent texture and good appearance.And there is no damage to the main vessels in the donor site.