游离桡侧副动脉穿支皮瓣修复手部软组织缺损

Free perforator flap of radial accessory artery for repairing soft tissue defect of hand

目的 探讨应用游离桡侧副动脉穿支皮瓣修复手部中小面积皮肤软组织缺损的方法和疗效。方法 2018年3月-2021年6月,收治合并深部组织外露的手部皮肤软组织缺损18例,软组织缺损面积:2.5 cm×5.0 cm~5.0cm×10.0 cm,应用游离桡侧副动脉穿支皮瓣修复。皮瓣轴线为三角肌止点至肱骨外上髁连线,同时解剖分离臂外侧或后侧皮神经分支重建皮瓣感觉,供区直接缝合。术后通过门诊和微信随访,观察皮瓣外形、感觉功能、患手活动功能及供区等恢复情况。结果 术后18例皮瓣全部成活,其中1例皮瓣术后血管蒂部血肿卡压,引起静脉危象,经拆线后,静脉危象解除,皮瓣顺利成活。18例均获得3~20个月随访,平均11个月。皮瓣外形美观,不臃肿,质地柔软,与受区相当。皮瓣感觉恢复S2~S3。患手各指屈伸功能恢复良好,供区仅遗留一线性瘢痕。按照中华医学会手外科分会功能评定:优15例,良3例。结论 游离桡侧副动脉穿支皮瓣修复手部软组织缺损,皮瓣外形美观,质地柔软,操作简便,解剖恒定,可重建皮瓣感觉,是修复手部软组织缺损较为理想的一种方法。

Objective To investigate the method and effect of free radial accessory artery perforator flap in repairing small and medium area skin soft tissue defect of hand.Methods From March 2018 to June 2021,18 cases of hand skin and soft tissue defect with deep tissue exposure were treated in our hospital.The defect area was about 2.5 cmx5.0 cm~5.0 cmx10.0 cm,and the free radial accessory artery perforator flap was used to repair the defect.The axis of the flap was the line from deltoid insertion to the external epicondyle of the humerus.Meanwhile,the lateral or posterior cutaneous nerve branches of the arm were dissected to reconstruct the sensation of the flap,and the donor area was sutured directly.The appearance,sensory function,movement function of the affected hand and donor area of the skin flap were observed through outpatient and wechat follow-up.Results All 18 cases of flaps survived after operation.Venous crisis was caused by entrapment of hematoma at the pedicle of blood vessel after skin flap operation.Venous crisis was relieved after suture removal and the skin flap survived successfully.All the 18 patients were followed up for 3 to 20 months,with an average of 11 months.The skin flap is beautiful in appearance,not bloated,soft in texture,and comparable to the receiving area.Skin flap sensory recovery S2~S3.Flexion and extension function of each finger of the affected hand recovered well,and only one linear scar remained in the donor area.According to the functional evaluation of the Hand Surgery Branch of the Chinese Medical Association,15 cases were excellent and 3 cases were good.Conclusion Free radial accessory artery perforator flap is an ideal method for repairing soft tissue defect of hand.The flap is beautiful in appearance,soft in texture,simple in operation,constant in anatomy,and can reconstruct the sensation of the flap.