以横动脉及趾底动脉为蒂的Flowthrough游离皮瓣修复指掌侧软组织缺损

目的 探讨应用以横动脉及趾底动脉为蒂的Flowthrough趾腓侧游离皮瓣,急诊修复手指掌侧软组织缺损及重建指端血运的临床疗效。方法 2018年9月-2020年7月,应用以横动脉及趾底动脉为血管蒂的Flowthrough趾腓侧游离皮瓣急诊修复指掌侧皮肤软组织缺损并重建血运11例,趾底动脉与指动脉近端吻合,横动脉与指动脉远端吻合,保留皮瓣横动脉分叉以远趾底动脉主干及血管穿支,趾底固有神经和指固有神经端端或端侧接合。结果 术后11例皮瓣全部成活,无动静脉危象及感染发生,伤口均一期愈合。其中1例因皮瓣下血肿行手术探查血肿清除术,皮瓣成活良好;3例术后半年对外形有更高要求,行皮瓣舒平术。皮瓣供区直接缝合4例,全厚皮片植皮7例,供区切口、植皮区全部一期愈合,无感染及植皮坏死发生。11例获6~21个月随访,未见明显瘢痕形成,足趾活动正常,皮瓣外形逼真,有螺纹,质地良好,两点辨别觉4~8 mm(健侧2~4 mm),行走、跑跳、负重等完全正常。按中华医学会手外科学会上肢部分功能评定试用标准评定:优9例,良2例,优良率100%。结论 以横动脉及趾底动脉为血管蒂的Flowthrough趾腓侧游离皮瓣急诊修复指掌侧皮肤软组织缺损,供区皮瓣血管恒定而且隐蔽,趾跖侧与受区指掌侧外形、质地相近,修复后效果极佳,而且能同时重建手指血运,并接合神经恢复皮瓣感觉,符合受区修复最大化、供区损伤最小化的治疗原则,值得临床推广应用。

Surgical treatment for traumatic transection of left common carotid artery

Injury to the supraaortic artery is a rare event, with poor prognosis and high mortality.1 Improvement of the outcome may lie on the combination of several aspects, including better pre-hospital care, use of emergency cardiopulmonary bypass （CPB）, improved surgical techniques and facilities, and advanced postoperative intensive care. Some researchers emphasized the importance of emergency CPB in the treatment and thought that it was responsible mainly for the improved outcome.2-6 However, there exists controversies about it.7-9 In this article, we reported that a patient with life-threatening hemorrhage due to traumatic transection of the left common carotid artery, who was admitted to our hospital in July 2003, was treated successfully with operations with help of emergency CPB and systemic hypothermia.