摘要
目的 探讨前臂游离骨间后动脉分叶穿支皮瓣修复多指皮肤软组织缺损的疗效。方法 回顾性分析2019年6月—2020年12月联勤保障部队第901医院显微骨科收治手指皮肤软组织缺损合并骨或(和)肌腱外露患者13例,男性9例,女性4例;年龄25~56岁,平均36.5岁。机器绞伤6例,重物砸伤4例,热压伤3例。通过术前多普勒超声探测穿支点,根据患指创面位置、形状及大小于同侧前臂设计游离骨间后动脉分叶穿支皮瓣,一次性修复多指创面。皮瓣切取6.0cm×3.0cm~15.0cm×3.0cm,平均9.0cm×3.5cm,供区创面直接缝合,皮瓣内可携带前臂背侧皮神经重建感觉。术后观察皮瓣血运、颜色、质地,携带皮神经者测量两点辨别觉;前臂供区外观;应用密歇根大学手概况问卷调查(MHQ)评定手部功能。结果 术后皮瓣全部成活良好,无血管危象发生。术后门诊随访3~12个月,平均5.0个月,手指皮瓣颜色、质地良好,2例携带皮神经的皮瓣末次随访两点辨别觉分别达6mm及8mm,前臂供区运动功能良好,仅留线状瘢痕。MHQ评定结果患者均对手部外观及功能满意。结论 游离骨间后动脉分叶穿支皮瓣具有质地软、厚薄适中、外形良好、可携带感觉神经等优点,能同时修复多个手指软组织缺损,供区直接闭合,具有较高的临床应用价值。
Objective To investigate the clinical effects of the forearm free dorsal interosseous artery polyfoliate perforator flap on repairing the skin defect in multiple fingers.Methods From Jun.2019 to Dec.2020,13 patients suffered multiple finger skin and soft tissue defects with bone or(and)tendon exposure who were treated in The 901th Hospital of the Joint Logistics Support Force of PLA were retrospectively collected.There were 9 males and 4 females;the age ranged from 25 to 56 years(average,36.5 years).Causes of injury:6 cases of machine injury,4 cases of heavy object injury and 3 cases of thermal compression injury.The perforator point of the flap was detected by preoperative Doppler ultrasound,then the free dorsal interosseous artery polyfoliate perforator flap was used to repair the defect according to the position,shape and size of the affected finger wound.Flap size was 9.0cm×3.5cm on average(range,6.0cm×3.0cm to 15.0cm×3.0cm),and the donor site was directly sutured.Forearm cutaneous nerve in the flap was helpful for reconstructing sensory function of the finger.The blood supply,color,texture of the flap and appearance of forearm donor area were observed after operation,and the two-point discrimination of those with cutaneous nerve was measured.Hand function was assessed by hand profile questionnaire(MHQ)of the University of Michigan.Results All flaps survived completely without vascular crisis.Postoperative outpatient follow-up period ranged from 3 to 12 months(average,5 months).The color and texture of the finger flap were good.The two-point discrimination of the flap with cutaneous nerve in the last follow-up was 6mm and 8mm,respectively in the two cases with cutaneous nerve.The motor function of the forearm donor area was good,leaving only linear scars.The MHQ evaluation results showed that the appearance and function of the hand were satisfactory.Conclusion The dorsal interosseous artery polyfoliate perforator flap has the advantages of soft texture,medium thickness,good shape and being capable of carry
作者
方鑫
胡沣
陈前永
董志远
符来想
Fang Xin;Hu Feng;Chen Qianyong;Dong Zhiyuan;Fu Laixiang(Department of Microscopic Orthopedics,The 901th Hospital of the Joint Logistics Support Force of PLA,Hefei 230061,China)
出处
《创伤外科杂志》
2022年第6期420-423,共4页
Journal of Traumatic Surgery
关键词
指损伤
软组织缺损
骨间后动脉
皮瓣
finger injury
soft tissue defect
dorsal interosseous artery
flap
