摘要
目的探讨前臂动脉化静脉皮瓣修复手指软组织缺损创面的手术方法与临床疗效。方法2013年1月至2019年10月,对13例伴有深部组织外露的手指软组织缺损应用动脉化静脉皮瓣进行修复。皮瓣设计于前臂,选择2条基本相互平行的浅静脉,其口径与受区血管口径接近,皮瓣长轴与静脉走行一致,且2条浅静脉将皮瓣宽度分成约3等分,将切取的游离皮瓣在显微镜下于2条血管中间处纵行切开,并切除宽约2 mm皮下组织至真皮下血管网,结扎2条血管之间交通支。皮瓣不倒置,切取面积3.5 cm×2.5 cm~7.0 cm×4.0 cm。皮瓣内2条血管近端分别与受区动脉和静脉吻合。结果13例皮瓣术后均顺利成活,其中9例获随访,随访时间3~23个月,平均11个月,门诊随访7例,电话随访2例;皮瓣质地柔软、无影响关节活动的现象,皮瓣稍臃肿;皮瓣TPD为9~18 mm,平均13 mm。结论前臂动脉化静脉皮瓣成活率高,功能满意,指腹化改变,位置表浅,切取容易,不牺牲主要动脉,是一种修复手指软组织缺损较为理想的方法。
Objective To explore the surgical method and clinical effect of forearm arterialized venous flap in repair of soft tissue defects of fingers.Methods A total of 13 cases of finger soft tissue defects with exposure of deep tissue were repaired with forearm arterialized venous flap from January,2013 to October,2019.The flap was designed in the forearm,and 2 parallel superficial veins were selected,the diameter of vein was similar to that at recipient site.The long axis of the flap was the same as that of the vein,and the width of the flap was divided into 3 equal parts by the 2 superficial veins.The free flap was cut longitudinally in the middle between 2 vessels under microscope,and a width of about 2 mm of the subcutaneous tissue was removed to the subdermal vascular network.The communicating branch between 2 vessels was ligated,and the subcutaneous tissue between 2 vessels was cut completely.The flap was not inverted,and the cut area was 3.5 cm×2.5 cm-7.0 cm×4.0 cm.The proximal ends of the 2 vessels in the flap were anastomosed with the arteries and veins of the recipient area.Results Thirteen flaps survived,and 9 patient entered follow-up for an average of 11(3-23)months.The flaps were soft and had no effect on the joint movement,slightly bloated.The TPD of flaps was 9-18 mm,with an average of 13 mm.Conclusion Forearm arterialized venous flap has the advantages of high survival rate,satisfactory function,finger pulp-type change,superficial location,easy harvest and no sacrifice of main artery.It is an ideal method for repairing finger soft tissue defects.
作者
曾德庆
王海博
余纯斌
卢文景
钟少开
王海文
ZENG Deqing;WANG Haibo;YU Chunbin;LU Wenjing;ZHONG Shaokai;WANG Haiwen(Department of Hand Surgery,Chashan Hospital of Guangdong Medical University,Dongguan,Guangdong Province 523380,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2021年第5期495-499,共5页
Chinese Journal of Microsurgery
基金
东莞市社会科技发展(一般)项目(202050715009865)。
关键词
静脉皮瓣
前臂
手指
软组织缺损
显微外科技术
Venous flap
Forearm
Fingers
Soft tissue defect
Microsurgical technique
