摘要
目的探讨应用静脉动脉化前臂静脉皮瓣游离移植一期修复手掌皮肤软组织缺损创面并重建掌浅弓的临床疗效。方法自2012年4月至2014年10月，对7例手掌皮肤软组织及掌浅弓缺损的手掌复杂性损伤患者，应用前臂掌侧静脉动脉化前臂静脉皮瓣游离移植修复。一期重建掌浅弓及各指总动脉，恢复各手指的血运，同时修复手掌皮肤软组织缺损创面。结果术后1例因感染截肢，1例皮瓣远端部分坏死、换药愈合，其余各手掌、指血运良好，皮瓣顺利存活。术后6例保肢成功者获得随访，时间为6-24个月（平均13．5个月），末次随访时皮瓣不臃肿、质地柔软，供区愈合好，参照英国医学研究会1954年制定的感觉功能评定标准评定皮瓣感觉，S21例，S33例，S3＋2例，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1例，良3例，可2例。结论应用静脉动脉化前臂静脉皮瓣游离移植，可重建掌浅弓及各指总动脉并同时修复手掌软组织缺损，具有手术简便、供区损伤小的优点，是修复手掌复杂性损伤的新选择。
Objective To investigate the clinical outcomes of one-stage repair of soft tissue defect of the palm and reconstruction of the superficial palmar arch with arterialized venous flow-through flap. Methods From April 2012 to October 2014, 7 cases of complex palm injury with beth soft tissue and superficial palmar arch defects were treated with the volar forearm flow-through venous flaps. The axial vein of the flap was inset between the damaged superficial palmar arch to repair the artery and perfuse the common digital arteries, as well as being arterialized to feed the flap that covered the soft tissue defect of the palm. Results The flaps and fingers survived with good perfusion, except 1 case of amputation due to infection and 1 case of distal flap necrosis and delayed healing. The 6 cases whose limbs were successfully salvaged had 6 to 24 months （average 13.5 months） follow-up. The final follow-up evaluation revealed good appearance and texture of the flaps and proper donor site healing. According to the sensory evaluation criteria established by British Medical Research Council in 1954, sensory recovery was graded as S2 in 1 case, S3 in 3 cases, and S3 ＋ in 2 cases. Based on the functional evaluation criteria of the upper extremity issued by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 1 case, good in 3 cases, and fair in 2 cases. Conclusion Application of flowthrough venous flap can simultaneously reconstruct superficial palmar arch defect and soft tissue defect of the palm. It has such advantages as being a simpler procedure and causing little injury to the donor site. It is a new option for repairing comolex palm iniuries.
出处
《中华手外科杂志》
CSCD
北大核心
2016年第1期37-39,共3页
Chinese Journal of Hand Surgery
基金
江苏徐州市医学青年后备人才培养工程基金（2014018）
关键词
外科皮瓣
手损伤
显微外科手术
掌浅弓
Surgical flaps
Hand injuries
Microsurgery
Superficial palmar arch
