目的 总结应用游离第一掌背动脉皮瓣修复伴有骨、肌腱外露的手指皮肤软组织缺损的方法 及疗效.方法自2014年6月至2017年6月,我们对10例伴有骨、肌腱外露的手指皮肤软组织缺损患者采用游离第一掌背动脉皮瓣移植修复,并选择性带入桡神经浅支重建皮瓣感觉.皮瓣切取面积为1.5 cm×4.5 cm～5.2 cm×6.0 cm.供区直接缝合或全厚皮片植皮修复.结果 术后所有皮瓣均顺利存活,未发生血管危象,皮瓣及供区切口均Ⅰ期愈合.所有患者均获得随访,时间为6～20个月,平均10个月.皮瓣外形、色泽均接近健侧,质地柔软.两点分辨觉为7～12 mm,平均8.5 mm.手功能按手指总主动活动度评定:优6例,良3例,可1例.结论 选择性带入桡神经浅支的游离第一掌背动脉皮瓣血运可靠,手术操作简单,能以较小的供区损伤有效覆盖创面,并获得较理想的外观、功能及感觉恢复.%Objective To summarize the operative procedure and clinical efficacy of the first dorsal metacarpal artery flap for repair of the finger soft tissue defects with bone and tendon exposure by free transplantation. Methods From June 2014 to June 2017, 10 cases of the finger soft tissue defects with bone and tendon exposure were treated by the first dorsal metacarpal artery flap transplantation, and the sensation of the flap was reconstructed using the superficial branch of the radial nerve. The area of the flap ranged from 1.5 cm×4.5 cm to 5.2 cm×6.0 cm. The donor sites were closed directly or by skin graft. Results All the flaps survived successfully without vascular crisis. Primary healing of the flaps and donor sites was achieved. All the cases were follow-up for 6 to 20 months, with an average of 10 months. The shape and color of the flap were close to the healthy side, and the texture was soft. Two-point discrimination was 7 to 12 mm with an average of 8.5 mm. Hand function was evaluated by the total active range of motion of the fingers. The results were excellent in 6 cases, good in 3 cases and fair in 1 case. Conclusion The free first dorsal metacarpal artery flap, which selectively included the superficial branch of the radial nerve, is a reliable and simple procedure. It can effectively cover the wound with lighter injury in donor site and obtain an ideal appearance, function and sensory recovery.
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