摘要
目的探讨含皮神经的改良前臂骨间背侧动脉带蒂皮瓣修复虎口挛缩的手术方式及临床疗效。方法我科自2015年1月至2019年5月收治31例虎口中重度挛缩患者,彻底松解虎口挛缩后,以尺骨茎突上1.5~2.5 cm处为旋转点,根据虎口处软组织缺损面积设计含皮神经的改良前臂骨间背侧动脉带蒂皮瓣逆行转移。软组织缺损面积为4 cm×2 cm~15 cm×6 cm,皮瓣切取面积为5 cm×2 cm-16 cm×6 cm。供区直接缝合或游离植皮修复。结果31例术后均获得随访,时间6~24个月,平均14个月。皮瓣无明显色素沉着、质地弹性好、外形美观,虎口挛缩均得到纠正,拇指对指、对掌、外展、内收功能均得到改善,腕部功能活动正常。依照中华医学会手外科学会上肢部分功能评定试用标准评价:优12例,良17例,可2例。皮瓣均恢复保护性感觉,达S2~S3O供区仅遗留植皮瘢痕。结论含皮神经的改良前臂骨间背侧动脉带蒂皮瓣是修复虎口挛缩软组织缺损的理想方案。
Objective To investigate the surgical method and clinical effect o£modified antebrachial dorsal interosseous artery pedicled flap containing cutaneous nerve for repair of thumb web contracture.Methods From January 2015 to May 2019,31 patients with moderate to severe thumb web contracture were treated.After the contracture was completely released,the modified antebrachial dorsal interosseous artery pedicled flap with cutaneous nerve was designed according to the soft tissue defect area,and 1.5 to 2.5 cm above the ulna styloid process was used as the rotation point.The area of soft tissue defect was 4 cm×2 cm to 15 cm×6 cm,and the area of flap was 5 cm×2 cm to 16 cm×6 cm.The donor site was repaired by direct suture or free skin grafting.Results All the patients were follow-up for 6 to 24 months with an average of 14 months.The skin flap had no obvious pigmentation with good elasticity and beautiful appearance.The thumb web contracture was corrected.The functions of thumb opposition,abduction and adduction were improved.The wrist function was normal.According to the evaluation standard of upper limb function of Hand Surgery Society of Chinese Medical Association,12 cases were excellent,17 cases were good and 2 cases were fair.The protective sensation was restored to S2 to S3.Only skin graft scar was left in donor site.Conclusion The modified antebrachial dorsal interosseous artery pedicled flap with cutaneous nerve is an ideal method to repair the soft tissue defect caused by thumb web contracture.
作者
赵光宗
张龙强
车力凡
李华壮
方军
Zhao Guangzong;Zhang Longqiang;Che Lifan;Li Huazhuang;Fang Jun(Department of Orthopedics,Weffang Yidu Central Hospital,Shandong 262500,China;Department of Quality Control,Weifang Yidu Central Hospital,Shandong 262500,China)
出处
《中华手外科杂志》
CSCD
北大核心
2021年第1期34-37,共4页
Chinese Journal of Hand Surgery
基金
山东省医药卫生科技发展计划项目(2018WS073)
北京医卫健康公益基金会(B187018)。
关键词
外科皮瓣
治疗结果
虎口挛缩
骨间背侧动脉
Surgical flaps
Treatment outcome
Thumb web contracture
Dorsal interosseous artery
