游离第二趾胫侧血流桥接皮瓣修复伴指动脉缺损的手指创面

摘要

目的 探讨游离第二趾胫侧血流桥接皮瓣修复伴指动脉缺损手指创面的临床疗效.方法 自2005年7月至2016年1月,我们共收治12例手指掌侧皮肤软组织合并指动脉缺损患者,应用游离第二趾胫侧皮瓣移植覆盖创面,同时利用该皮瓣中的第二趾胫侧趾底固有动脉桥接修复指固有动脉缺损,恢复患指远端血供.皮瓣供区创面植皮修复.术后超声检测桥接血管通畅情况.结果 术后12例皮瓣全部存活,皮瓣外形满意,质地接近手指掌侧皮肤.供区无功能障碍.术后随访时间为6～36个月,平均18个月,患指指端温暖,无怕冷.术后1个月超声多普勒检测显示桥接血管血流通畅.皮瓣两点分辨觉恢复至8～12 mm,平均10 mm.足部供区植皮无破溃,不影响穿鞋及行走.结论 游离第二趾胫侧血流桥接皮瓣质地优良,可同时修复手指掌侧皮肤软组织合并指动脉缺损,是治疗该损伤的一种较为满意的方法.%Objective To explore the clinical effects of free tibial second toe flow-through flap for repair of finger wound with artery defect.Methods From July 2005 to January 2016,12 cases ofvolar soft tissue and artery defects of fingers were covered by free second toe medial flap,and proper digital artery defect was bridged by proper plantar digital artery of tibial second toe to restore the blood supply of distal finger.The donor site was repaired by full-thickness skin graft.Blood flow was detected by Doppler probe 1 month after operation.Results Postoperatively all the flaps survived uneventfully.The appearance and texture of the flap were satisfactory.No dysfunction occurred in donor sites.All the patients were follow-up for 6 to 36 months with an average of 18 months.The fingertips were warm without cold intolerance.Blood flow of bridged arteries was detected by Doppler probe.Two-point discrimination of the flaps was 8 to 12 mm with an average of 10 mm.No ulceration occurred in the skin graft of donor sites.Wearing shoes and walking were not affected.Conclusion The texture of free tibial second toe flow-through flap is good.It is an ideal method to repair volar soft tissue and artery defects of fingers at one-stage.