指掌侧固有动脉穿支(关节支)皮瓣联合掌背动脉皮瓣接力修复手指末节背侧软组织缺损

Reconstruction of soft tissue defects in distal segment of dorsal fingers with a perforator(joint branch) flap of proper palmar digital artery combined with dorsal metacarpal artery flap

目的:探讨应用指掌侧固有动脉穿支(关节支)皮瓣联合掌背动脉皮瓣接力修复手指末节背侧软组织缺损的手术方法和疗效。方法:2019年1月-2022年6月,青岛大学附属医院手足显微外科共收治9例手指末节背侧软组织缺损伴伸肌腱止点撕脱患者,缺损面积为1.0 cm×1.0 cm~2.5 cm×2.0 cm,钢丝重建伸肌腱止点,采用近节指掌侧固有动脉穿支(关节支)皮瓣修复创面,掌背动脉皮瓣接力修复近节皮瓣供区,术后门诊、微信等方式随访,评估近、远期皮瓣成活情况、皮瓣外形、瘢痕情况及指骨间关节、掌指关节功能。结果:指掌侧固有动脉穿支(关节支)皮瓣和掌背动脉穿支筋膜皮瓣全部成活,术后1例指掌侧固有动脉穿支(关节支)皮瓣出现发紫、张力性水疱,皮瓣蒂部在术后36~48 h给予部分缝线拆除,术后7 d皮瓣颜色红润,指体末节关节及甲床伤口愈合良好,未见红肿及感染。术后随访时间为5~12个月,平均9个月,指体末节皮肤与近节背侧及掌背皮肤外形、色泽、质地相似,感觉恢复良好,均超过S 3,TPD为8~10 mm,平均9.5 mm。按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,结果优7例,良2例。结论:指掌侧固有动脉穿支(关节支)皮瓣联合掌背动脉皮瓣接力修复手指末节背侧软组织缺损是一种简单、安全的治疗方案,功能恢复快,外形美观。

Objective To explore the surgical procedure and effect of reconstruction of soft tissue defects in the distal segment of dorsal finger with a perforator(joint branch)flap of proper palmar digital artery combined with a dorsal metacarpal artery flap.Methods From January 2019 to June 2022,9 patients with soft tissue defects in distal dorsal finger,mostly with avulsion at the extensor tendon insertion point,were treated in Department of Hand and Foot Microsurgery,the Affiliated Hospital of Qingdao University.The defect areas were 1.0 cm×1.0 cm-2.5 cm×2.0 cm.Steel wires were used to reconstruct the extensor tendon insertion point.The defects were reconstructed by a perforator(joint)flap of proximal phalanx artery and a dorsal metacarpal artery flap was used to repair the donor site for proximal flap.Postoperative follow-up and evaluation included flap survival,flap appearance,scars and function of interphalangeal and metacarpophalangeal joints,through outpatient clinical,WeChat and so on.Results The flap of digital artery perforator(joint branch)and the fasciocutaneous flap of dorsal metacarpal artery all survived.One flap of the digital artery perforator(joint branch)appeared purple and tension blisters after surgery.The stitches of the pedicle of the flap were partially dismantled at 36-48 hours after surgery.The flap was then turned to ruddy in colour 7 days after surgery.The wounds of the distal finger joint and nail bed healed well without redness and infection.The postoperative follow-up lasted for 5 to 12 months,9 months in average.The appearance,colour and texture of the skin at distal finger were similar to those at the dorsal proximal finger and dorsal palm.Sensation recovered well,all flaps exceeding S3.The two-point resolution(TPD)was 8-10 mm,with an average of 9.5 mm.According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,5 cases were in excellent and 4 in good.Conclusion The perforator(joint branch)flap of proper palmar digital artery combined with a dorsal metacarpal artery flap is simple and safe treatment.It has a fast functional recovery with an aesthetic appearance in reconstruction of the soft tissue defect in distal segment of dorsal finger.