腓肠内侧动脉穿支皮瓣游离修复手部创面九例报告

Free medial sural artery perforator flaps in repairing soft tissue defect of hands

目的探讨小腿腓肠内侧动脉穿支皮瓣游离修复手部创面的临床疗效。方法回顾分析2018年7月至2022年11月,我院手外科9例采用小腿腓肠内侧动脉穿支皮瓣游离修复手部创面的患者临床资料,其中男6例,女3例,年龄27~58岁,平均40岁。外伤机制:重物轧伤5例,电动锯切割伤3例,热压伤1例。本组创面面积3.0 cm×4.2 cm~4.0 cm×6.0 cm,切取皮瓣面积4.0 cm×5.0 cm~5.0 cm×6.5 cm,9例皮瓣小腿供区皆可直接缝合。结果9例皮瓣术后全部成活,供、受区伤口均一期愈合,随访6~30个月,色泽、质地与手部皮肤相似,皮瓣感觉S3,7例皮瓣无明显臃肿,2例皮瓣有部分臃肿,小腿瘢痕隐蔽,其中有3例患者供区瘢痕增生。结论小腿腓肠内侧动脉穿支血管解剖恒定,供区隐蔽,皮瓣血运丰富,有效抗感染,皮瓣下脂肪含量少,游离移植覆盖手部创面,取得了良好的临床效果。

Objective To investigate the clinical effect of free medial sural artery perforator flap in repairing soft tissue defect of hands.Methods From July 2018 to November 2022,Department of Hand Surgery of my hospital used medial sural artery perforator flaps to repair soft tissue defect of hands for 9 cases,including 6 male cases and 3 female cases,with an average age of 40 years(range:27-58 years).Trauma mechanism:5 cases of heavy rolling injury,3 cases of electric saw cutting injury,and 1 case of thermal compression injury.The wound area was long 3.0 cm×wide 4.0 cm-long 4.0 cm×wide 6.0 cm,and the flap area was long 4.0 cm×wide 5.0 cm-long 5.0 cm×wide 6.5 cm.All 9 flap donor areas can be directly sutured.Results All 9 flaps survived,and the wounds of the donor and recipient areas primary healed.Follow-up ranged 6-30 months postoperatively.The flaps were not significantly bloated,the color and texture were similar to the skin of the hand,the two-point discrimination was S2-S3,and the calf scars were hidden with no obvious hyperplasia.Conclusions The perforators of the medial sural artery have constant anatomy,hidden donor area,abundant blood,effective anti-infection,and low fat content under the flap.The repair of soft tissue defect of hands by free grafting achieves good clinical results.