摘要
目的探讨采用游离骨间背动脉穿支皮瓣修复多指皮肤软组织缺损的临床效果。方法该研究为回顾性观察性研究。2020年4月—2022年6月,重庆长城骨科医院手显微外科收治7例多指皮肤软组织缺损患者,其中男4例、女3例,年龄27~54岁。7例患者共18指受伤,其中4指受累者1例、3指受累者2例、2指受累者4例。Ⅰ期清创后皮肤软组织缺损面积为3.0 cm×2.0 cm~7.5 cm×3.0 cm。所有患者均行Ⅰ期清创、Ⅱ期骨间背动脉穿支皮瓣移植修复创面、Ⅲ期皮瓣断蒂及分指。皮瓣切取面积为4.0 cm×2.5 cm~10.5 cm×3.5 cm。将骨间背动脉与指固有动脉进行端端吻合,将2条骨间背动脉的伴行静脉与手指2条皮下浅静脉进行端端吻合。采用充分减张后皮下缝合的方法处理供区。观察Ⅲ期术后皮瓣成活情况。Ⅲ期术后每3个月进行1次随访,观测手指术区外观、质地、感觉情况,手指关节活动度,供区创面愈合情况。末次随访时,根据中华医学会手外科学会上肢部分功能评定试用标准评定手指功能。结果7例患者Ⅲ期术后皮瓣均成活。Ⅲ期术后随访6~36个月,仅3例患者皮瓣臃肿,于3个月及以后行皮瓣减容手术,其余患者手指外观恢复良好;6例患者供区仅遗留线性瘢痕,1例患者出现供区瘢痕增生且经激光治疗后明显好转。末次随访时,手指功能评定为优者5例、良者2例。结论采用以多条骨间背动脉穿支为蒂的皮瓣修复多指皮肤软组织缺损,术中仅吻合一套血管且不损伤主干血管,降低了术后血管危象的发生率;分指手术操作简单,术后供受区外观和功能较佳,值得临床推广。
Objective To investigate the clinical effects of free dorsal interosseous artery perforator flaps in repairing multi-finger skin and soft tissue defects.Methods The study was a retrospective observational study.From April 2020 to June 2022,7 patients with multi-finger skin and soft tissue defects were admitted to the Department of Hand Microsurgery of the Chongqing Great Wall Orthopaedic Hospital,including 4 males and 3 females,aged 27 to 54 years.A total of 18 fingers were injured in 7 patients,of which 4 fingers were involved in 1 case,3 fingers were involved in 2 cases,and 2 fingers were involved in 4 cases.The area of skin and soft tissue defects after stageⅠdebridement ranged from 3.0 cm×2.0 cm to 7.5 cm×3.0 cm.All the patients underwent stageⅠdebridement,stageⅡinterosseous dorsal artery perforator flap transplantation to repair the wound,and stageⅢflap pedicle division and finger-split.The incision area of the flap was 4.0 cm×2.5 cm to 10.5 cm×3.5 cm.The interosseous dorsal artery was anastomosed with the proper digital artery by end to end,and the concomitant veins of 2 interosseous dorsal arteries were anastomosed with 2 superficial subcutaneous veins of the fingers by end to end.The donor area was treated by subcutaneous suture after full reduction of tension.The survival of flap after stageⅢwas observed.Follow-up was conducted once every 3 months after the stageⅢoperation to observe the appearance,texture,sensation of the operative areas in fingers,the range of motion of the finger joint,and the wound healing of the donor area.At the last follow-up,the function of fingers was assessed according to the trial standard of upper limb partial function assessment of the Hand Surgery Society of Chinese Medical Association.Results All the flaps in 7 patients survived after stageⅢoperation.During follow-up of 6 to 36 months after stageⅢoperation,only 3 patients with bloated flap underwent the flap volume reduction operation in 3 months and later,and the finger appearance in the other patients
作者
郑云
程良坤
崔留超
谭玉忠
田林
Zheng Yun;Cheng Liangkun;Cui Liuchao;Tan Yuzhong;Tian Lin(Department of Hand Microsurgery,Chongqing Great Wall Orthopaedic Hospital,Chongqing 400041,China)
出处
《中华烧伤与创面修复杂志》
CAS
CSCD
北大核心
2024年第5期476-481,共6页
Chinese Journal of Burns And Wounds
