尺桡动脉穿支皮瓣与腹部带蒂皮瓣在手和腕部软组织缺损中的应用与比较研究

Comparative Study and Application of Flap Based on Perforating Branch of Ulnar or Radial Arteryand Abdominal Pedicled Flap for Soft Tissue Reconstruction of the Hand and Wrist

目的:比较尺桡动脉穿支皮瓣与腹部带蒂皮瓣在重建手、腕周围软组织缺损的效果及应用。方法:回顾我院2016年6月-2020年6月收治的符合该项研究标准的25例采用腹部带蒂皮瓣修复手和腕部软组织缺损的患者。随访我院2020年6月-2021年12月收治的符合该项研究标准的20例采用尺桡动脉穿支皮瓣修复手和腕部软组织缺损的患者。对2组患者一般资料的比较,差异无统计学意义(P>0.05),具有可比性。然后对2组患者皮瓣的存活、供区并发症、美观、住院时间、住院费用、患肢功能影响程度进行比较。结果:2组患者皮瓣的再存活率、供区并发症、住院时间的比较上差异均无统计学意义(P>0.05);在美观、住院费用、患肢功能影响程度的比较上,2组患者差异有统计学意义(P<0.05)。尺桡动脉穿支皮瓣因不需2次手术断蒂,费用更低,在匹配度、美观、患肢功能影响程度上效果更佳。结论:尺桡动脉穿支皮瓣与腹部带蒂皮瓣均是重建手、腕周围软组织缺损的可靠方法。尺桡动脉穿支皮瓣不需2次手术断蒂,患者早期不需卧床,住院时间较短及费用相对较低,可早期行患肢功能锻炼,患者相对容易接受及满意度较高;腹部带蒂皮瓣不存在皮瓣供区血管解剖分离等技术性难题需要解决,值得在基层医院进行推广应用。

Objective:To compare the clinical efficacy and application of flap based on perforating branch of ulnar or radial artery and abdominal pedicle flap for soft tissue reconstruction of the hand and wrist.Methods:Back in June 2016 to June 2020 period Qingyuan peoples Hospital admitted to conform to the standard of the study of 25 cases of patients whoes used abdominal pedicle flap for soft tissue reconstruction of the hand and wrist.Follow-up in June 2020 to July 2022 period Qingyuan peoples Hospital admitted to conform to the standard of the study of 20 cases of patients whoes used flap based on perforating branch of ulnar or radial artery for soft tissue reconstruction of the hand and wrist.The general data of the two groups of patients were compared,the difference was not statistically significant(P>0.05),with comparability.Then the flap survival,donor complications,aesthetics,length of hospital stay,hospitalization expenses,influence degree of affected limb function,patient satisfaction and acceptance were compared between the two groups.Results:The general data of the two groups of patients were compared,the difference was not statistically significant(P>0.05),with comparability(shown in Table 1).There was no significant difference in the survival rate,donor site complications and hospital stay between the two groups(P>0.05).There were significant differences between the two groups in aesthetics,hospitalization expenses,influence degree of affected limb function,patient satisfaction and acceptance(P<0.05).Because the perforator flap of ulnar or radial artery does not need secondary operation to break the pedicle,the cost is lower,and the effect is better in matching degree,beauty,affected limb function,patient satisfaction and acceptance.Conclusion:Flap based on perforating branch of ulnar or radial artery and abdominal pedicled flap are reliable methods for soft tissue reconstruction of the hand and wrist.The perforator flap of ulnar or radial artery does not need secondary operation to break the pedicle,the patients do not need to stay in bed in the early stage,the hospital stay is short and the cost is relatively low,and the functional exercise of the affected limb can be carried out in the early stage,which is relatively easy to accept and satisfactory to the patients;The abdominal pedicled skin flap has no technical problems such as anatomical separation of blood vessels in the flap donor area,which needs to be solved,and is worthy of popularization and application in grass-roots hospitals.