逆行穿支皮瓣接力修复指端软组织缺损的临床应用

Clinical application of retrograde perforator flap relay for repair of soft tissue defects at the fingertips

目的讨论逆行穿支皮瓣接力修复指端软组织缺损及指背供区创面的临床应用。方法自2020年3月至2022年8月我们收治手指远端软组织缺损患者7例7指,应用指动脉皮穿支逆行岛状皮瓣修复缺损创面,皮瓣供区以掌背动脉指蹼穿支为蒂的接力皮瓣修复,切取皮瓣面积为1.5 cm×2.0 cm~2.0 cm×3.0 cm。皮瓣切取后通过皮下隧道或明道转移覆盖受区,掌背部皮瓣供区直接缝合。结果术后7例7指皮瓣全部存活。随访时间为3~13个月,平均8个月,皮瓣外观、弹性好,肤色质地与健侧无明显差异,外观无臃肿,伤指活动功能满意,无肌腱粘连和关节僵硬。皮瓣两点分辨觉达7~10 mm,平均8 mm。手功能按总主动活动度(total active motion,TAM)评定:优6例,良1例。患者对伤指的外形和功能满意。结论采用指动脉皮穿支逆行岛状皮瓣修复缺损创面,皮瓣供区以掌背动脉指蹼穿支为蒂的接力皮瓣修复,操作简单,不牺牲主干血管,兼顾耐用性和美观,供区可直接缝合,临床疗效满意。

Objective To discuss the clinical efficacy of relay retrograde perforator flaps for repairing soft tissue defects at the fingertips and wounds in the dorsal finger donor area.Methods From March 2020 to August 2022,7 patients with soft tissue defects at the distal end of the fingers were treated in our hospital.The reverse island skin flap with the perforator of the digital artery was used to repair the defect wound.The donor area of the flap was repaired with a relay flap pedicled with the perforator of the dorsal metacarpal artery web.The skin flap was cut with an area of 1.5 cm×2.0 cm to 2.0 cm×3.0 cm.After the flap was cut,it was transferred through a subcutaneous tunnel or open channel to cover the recipient area,and the dorsal or volar flap donor site was directly sutured.Results All flaps of 7 cases(7 fingers)survived after surgery.The follow-up period was 3 to 13 months,with an average of 8 months.The skin flap had good appearance and elasticity,no significant difference in skin color and texture compared to the healthy side,no swelling in appearance,satisfactory finger movement function,and no tendon adhesion or joint stiffness.The two-point discrimination of the flap was 7 to 10 mm,with an average of 8 mm.The hand function was evaluated based on total active motion(TAM).The result was excellent in 6 cases and good in 1 case.The patient was satisfied with the appearance and function of the injured finger.Conclusion The reverse island skin flap with the perforator of the digital artery skin is used to repair the defect wound.The relay skin flap with the perforator of the dorsal metacarpal artery finger web as the pedicle is used in the flap donor site for repair,which is simple in operation,does not sacrifice the main blood vessels,and takes into account durability and aesthetics.The donor site can be directly sutured,and the clinical efficacy is satisfactory.