游离同侧双蒂双腓浅动脉穿支皮瓣修复同指或邻指2处创面

Repair of two wounds in the same or adjacent digits with free ipsilateral double pedicled superficial peroneal artery perforator flap

目的探讨游离同侧双蒂双腓浅动脉穿支皮瓣同时修复同指或邻指2处创面的手术方法及临床疗效。方法自2017年11月至2021年8月,苏州瑞华骨科医院手外科对12例同指或邻指2处创面的患者,采用游离同侧双蒂双腓浅动脉穿支皮瓣同时修复。12例中,1例分布在示指的掌侧和背侧,1例分布于拇、示指,6例分布于示、中指,3例分布中、环指,1例分布环、小指;手指缺损创面面积为1.5 cm×0.8 cm~6.0 cm×3.5 cm,皮瓣切取面积为2.0 cm×1.2 cm~8.0 cm×4.0 cm。术后每月定期随访,记录受区、供区恢复情况。结果12例24块皮瓣全部一期成活,未发生血管危象,成活率100%。术后随访时间4~18个月,平均10个月。受区皮瓣无色素沉着,瘢痕无明显增生及疼痛,皮瓣均恢复保护性感觉,未测出TPD,皮瓣耐磨、无破溃,皮瓣质地柔软、弹性好,皮瓣遇冷无发紫,皮瓣无明显臃肿,12例23指功能恢复根据手指总主动活动度(TAM)测定法评定,优3指,良15指,可5指,优良率78.26%;供区线形瘢痕形成,瘢痕无明显增生及疼痛,瘢痕周围及远端皮肤感觉正常,指尖血运正常。结论游离同侧双蒂双腓浅动脉穿支皮瓣同时修复同指或邻指2处创面,手术操作简单,只需一个供区,供区损伤小,皮瓣血供可靠,是一种有效的修复方法。

Objective To explore the surgical method and clinical effect of harvesting 2 ipsilateral free pedicled perforator flaps from a single donor site of superficial peroneal artery in reconstruction of 2 defects in same or adjacent digits.Methods From November 2017 to August 2021,12 patients with 2 defects in same or adjacent digits were treated in the Department of Hand Surgery,Suzhou Ruihua Orthopaedic Hospital with 2 ipsilateral free pedicled perforator flaps from a single donor site of superficial peroneal artery.Among the patients,1 had the defect in dorsal and palmar of index finger,1 in thumb and index finger,6 in index and middle fingers,3 in middle and ring fingers,and 1 in ring and little fingers.The size of digit defects was 1.5 cm×0.8 cm-6.0 cm×3.5 cm.The size of flaps was 2.0 cm×1.2 cm-8.0 cm×4.0 cm.All the patients were included in postoperative monthly follow-up to assess the recovery of recipient and donor sites at outpatient service,by telephone or WeChat.Results All 24 flaps in 12 patients survived without vascular compromise and achieved 100%of survival rate.The follow-up period ranged from 4 to 18 months,with an average of 10 months.Six patients were treated with additional flap thinning and plastic surgery at 4 months after the primary surgery due to slightly bloated flaps.Otherwise,all the flaps in the recipient site had neither pigmentation,obvious hyperplasia nor scar pain.All flaps gained the protective sensations,however the assessment of TPD was not conducted.The flaps were wear-resist and had no ulceration.The texture of the flaps was soft with good elasticity,and the flap did not turn to purple or swelling when in cold.The functional recovery of 23 digits in 12 patients was evaluated according to the total active mobility(TAM)of the digits.It achieved excellent in 3 digits,good in 15 digits,and fair in 5 digits,with an excellent and good rate of 78.26%.A linear scar appeared at the donor site without obvious hyperplasia or scar pain.There were normal sensations around the scar and at the digit-tips.The blood supply to the digit-tips was normal.Conclusion Harvest of multiple free pedicled perforator flaps from a single donor site of superficial peroneal artery is an effective method in reconstruction of 2 defects in same or adjacent digits at the same time.It has advantages of being a simple surgery procedure by sacrificing only one donor site.It achieves a minimal damage to the donor site and a reliable blood supply of the flap.