桡动脉掌浅支微型皮瓣嵌合桡侧腕屈肌肌腱游离移植修复手指背侧复合组织缺损

Free chimeric mini-flap pedicled with superficial palmar branch of radial artery with flexor carpi radialis tendon in reconstruction of composite tissue defect of dorsal fingers

目的探讨桡动脉掌浅支微型皮瓣嵌合桡侧腕屈肌肌腱游离移植修复手指背侧复合组织缺损的手术方法和临床疗效。方法2020年1月至2022年12月,宁波大学附属第一医院整形修复重建外科收治6例6指指背软组织及伸肌腱联合损伤患者,软组织缺损面积1.5 cm×1.8 cm~2.5 cm×3.0 cm,伸肌腱缺损长度1.5~2.5 cm,采用同侧桡动脉掌浅支微型皮瓣嵌合桡侧腕屈肌肌腱游离移植修复,皮瓣供区直接缝合,观察皮瓣血运及成活情况,分别于术后第1、3、6、12、18、24个月通过门诊复诊及家访随访,外地不方便来院的患者通过微信、电话的方式进行随访,主要随访内容为皮瓣的颜色、质地、外形、感觉及伤指各关节功能情况。结果术后6例6指皮瓣全部成活,未出现血管危象,皮瓣供区Ⅰ期愈合,全部获得随访,随访时间6~22个月,平均11.3个月,皮瓣色泽、质地与指背皮肤相似,外形不臃肿。3例缝接神经,皮瓣感觉恢复达S_(3)^(+),TPD分别为7.6 mm、7.9 mm、8.3 mm,平均7.93 mm;3例未缝接神经,感觉恢复达S_(3)^(+),供区无并发症,按中华医学会手外科学会上肢部分功能评定试用标准,优4例,良2例。结论桡动脉掌浅支微型皮瓣嵌合桡侧腕屈肌肌腱游离移植,具有血供可靠、回流充分、能桥接血管神经及肌腱、供区损伤小、术后效果满意的优点,是修复手指复合组织缺损较为理想的方法。

ObjectiveTo explore the surgical procedure and clinical efficacy of free chimeric tendon mini-flap pedicled with superficial palmar branch with flexor carpi radialis of radial artery in reconstruction of the dorsal finger composite tissue defects.MethodsFrom January 2020 to December 2022,6 fingers(6 patients)with combined dorsal soft tissue and extensor tendon defects were treated in the Department of Plastic and Reconstructive Surgery,the First Affiliated Hospital of Ningbo University.The ipsilateral free chimeric flexor carpi radialis tendon mini-flap pedicled with superficial palmar branch of radial artery was used to reconstruct the soft tissue defects that sized 1.5 cm×1.8 cm-2.5 cm×3.0 cm and the extensor tendon defects ranged 1.5-2.5 cm in length.The flap donor sites were directly sutured.Blood supply and survival of the flaps were observed after surgery.Postoperative follow-ups were scheduled at the 1,3,6,12,18 and 24 months after surgery and mainly conducted at the outpatient clinic and by home visits.Patients who were inconvenient to visit the hospital were reviewed through WeChat or telephone interviews.The follow-up included the colour,texture,appearance,sensation of the flap and functional status of the affected fingers.ResultsAfter surgery,all 6 flaps survived without any incidence.All flap donor sites achieved stage I healing.The postoperative follow-up lasted 6-22(mean 11.3)months.The colour and texture of the flaps were similar to those of the skin of dorsal finger,without bulky appearance.For the 3 flaps that had nerve anastomoses,the sensation recovery of the flap achieved to S_(3)^(+),with TPD at 7.6 mm,7.9 mm and 8.3 mm,respectively,and 7.93 mm in average.For the 3 flaps without nerve anastomosis,the sensation recovery of the flap achieved S_(3)^(+).No complication occurred at the donor sites.According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,4 patients were in excellent and 2 in good.ConclusionTransfer of free chimeric flexor carpi radialis tendon mini-flap pedicled with superficial palmar branch of radial artery in reconstruction of the soft tissue defect in dorsal finger offers the advantages of reliable blood supply,sufficient blood reflux,bridging blood vessels,nerves and tendons,a minimal damage to the donor site and satisfactory postoperative outcome.It is an ideal surgical procedure for reconstruction of the composite tissue defects in dorsal finger.