摘要
目的：通过对指固有动脉终末背侧支解剖学观察,总结指固有动脉终末背侧支走行、吻合规律,探讨指固有动脉终末背侧支皮瓣修复指端皮肤缺损的手术方法和临床疗效。方法2011年5月—2014年5月,对10只新鲜手标本进行红色乳胶灌注,解剖观察指固有动脉终末背侧支血管的分布规律和特点。回顾性分析唐山市第二医院手外科同期以指固有动脉终末背侧支供血的指背皮瓣分别修复示指、中指、环指、小指指端皮肤缺损共49例58指患者的临床资料,其中示指指端缺损21指,中指皮肤缺损12指,环指皮肤缺损16指,小指皮肤缺损9指；合并骨折10例12指,合并肌腱断裂或缺损12例16指,合并血管神经损伤6例7指。同指修复31例36指,邻指修复18例22指；皮瓣切取面积10 mm ×8 mm -22 mm ×18 mm。结果显微解剖观察显示,示指、中指、环指、小指指固有动脉中节远端背侧支位于中节指骨颈部,即终末背侧支位置恒定。临床应用指固有动脉终末背侧支供血皮瓣修复指端缺损49例58指,皮瓣均成活,其中47例55指获6-29个月随访,平均18.6个月,皮瓣外观及手指功能恢复满意。皮瓣感觉恢复平均达 S3＋,两点辨别觉6-9 mm,平均7.4 mm。供区无并发症。结论指固有动脉终末背侧支血管发出位置恒定,以终末背侧支供血切取皮瓣血供可靠、不牺牲主要血管,操作简便、安全,术后效果满意,是修复指端皮肤软组织缺损较为理想的方法。
Objective To dissect and measure the terminal dorsal cutaneous branches of digital inherent artery in fresh hand specimens. Then explore the therapeutic effect of island flap based on terminal dorsal cutaneous branches of digital inherent artery to repair defect at the same or adjacent finger. Methods From May 2011 to May 2014, the origin, courses and distribution of terminal dorsal cutaneous branches of digital inherent artery from 10 fresh hand specimens were perfused by using red latex. Fifty-eight fingers in 49 cases with skin defects were treated with island flap based on terminal dorsal cutaneous branches of digital inherent artery for skin defect at the same or adjacent finger in Department of Hand Surgery of the Second Hospital of Tangshan. There were 21 index fingers, 12 middle fingers, 16 ring fingers and 9 little fingers. The size of the flaps ranged from 10 mm × 8 mm to 22 mm × 18 mm. Results The distal dorsal branch lay at the neck of the middle phalanx, namely the terminal dorsal branch. All flaps of 49 cases survived successfully. The 6 - 29 months′ follow up showed that all these flaps recovered with satisfying texture, grade S3 ＋ sensation,and 6 - 9 mm two point discrimination. There were no obvious complications of the donor site. Conclusions It does not sacrifice the major artery and can restore good flap contour by using the flap based on terminal dorsal cutaneous branches of digital inherent artery to repair the defect at end of finger. The treatment of finger cutaneous defect with the flap is recommendable. It can be easily and conveniently performed.
出处
《中华解剖与临床杂志》
2015年第5期418-422,共5页
Chinese Journal of Anatomy and Clinics
基金
河北省医学科学研究重点课题计划项目（ZD201210403）
关键词
软组织损伤
指损伤
外科皮瓣
修复外科手术
Soft tissue injuries
Finger injuries
Surgical flaps
Reconstructive surgical procedures
