桡动脉穿支腕横纹皮瓣桥接修复手指环形缺损疗效观察

发布时间：2018-11-20 06:41

【摘要】：目的探讨桡动脉穿支腕横纹皮瓣桥接修复手指环形缺损的疗效。方法 2013年6月—2016年3月,采用桡动脉穿支腕横纹皮瓣桥接修复20例(21指)手指环形缺损。其中男14例,女6例;年龄12~61岁,平均39.3岁。致伤原因:机器绞压伤9例,交通事故伤6例,热压伤2例,撕脱伤3例。受伤指别:示指6例,中指6例,环指3例,小指6例。缺损合并骨、肌腱、血管、神经外露。其中急诊手术17例,受伤至手术时间0.5~5.5 h,平均3 h;择期手术3例,受伤至手术时间7~10 d,平均8.5 d。利用该皮瓣中的桡动脉掌浅支桥接修复指固有动脉,恢复手指血运;19例供区可直接缝合,1例植皮修复。结果术后1例皮瓣远端部分皮肤血疱形成,经换药后愈合;余皮瓣均成活,创面Ⅰ期愈合。供区切口及创面均Ⅰ期愈合,外观良好、瘢痕小。20例均获随访,随访时间6~24个月,平均12个月。术后手指外观恢复良好,皮瓣质地、外形满意。术后6个月皮瓣两点辨别觉为6~13 mm,平均9 mm;患指功能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13例,良4例,可3例,优良率85%。结论桡动脉穿支腕横纹皮瓣是修复手指环形缺损较理想的方式。
[Abstract]:Objective to investigate the effect of radial artery perforating carpal transverse flap for repairing finger ring defect. Methods from June 2013 to March 2016, 20 cases (21 fingers) of finger ring defect were repaired with radial artery perforator wrist transverse flap. Among them, 14 cases were males and 6 cases were females, the age was 1261 years (mean 39.3 years). The causes of the injury were: mechanical strangulation injury in 9 cases, traffic accident in 6 cases, hot pressure injury in 2 cases and avulsion injury in 3 cases. There were 6 cases of finger injury, 6 cases of middle finger, 3 cases of ring finger and 6 cases of small finger. Defects associated with bone, tendon, blood vessels, and nerve exposure. 17 cases were operated in emergency department, the time from injury to operation was 0.5 ~ 5.5 h (mean 3 h), and 3 cases from elective operation to 7 ~ 10 d (average 8.5 d). The superficial palmar branch of the radial artery was used to repair the digital artery to restore the blood flow of the finger, 19 cases could be sutured directly, and 1 case was repaired with skin graft. Results Blood blister of the distal part of the flap was formed in one case, and healed after dressing change. All the remaining flaps survived and the wound healed in the first stage. The donor incision and wound healed in the first stage with good appearance and small scar. 20 cases were followed up for 624 months with an average of 12 months. After operation, the appearance of the fingers recovered well, the skin flap texture and appearance were satisfactory. Six months after operation, the two-point discriminant perception of the flap was 6 ~ 13 mm, and the average affected finger function was 9 mm; according to the evaluation criteria of the upper limb function of the Chinese Medical Association: excellent 13 cases, good 4 cases, fair 3 cases, excellent and good rate 85%. Conclusion Radial artery perforating carpal transverse flap is an ideal method for repairing finger ring defect.
【作者单位】：平顶山市平煤神马医疗集团总医院烧伤整形科;徐州仁慈医院手足显微外科;
【分类号】：R658.2

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