带掌长肌腱动脉化静脉皮瓣在修复手指背侧复合组织缺损中的应用

摘要

目的 探讨带掌长肌腱动脉化静脉皮瓣修复手指背侧复合组织缺损的应用方法 及临床疗效.方法2012年5月-2017年8月,对8例手指背侧复合组织缺损患者应用同侧前臂带掌长肌腱动脉化静脉皮瓣游离修复手指背侧复合组织缺损创面,皮瓣顺行移植,皮瓣内静脉分别与手指动、静脉吻合,皮瓣内掌长肌腱与受区伸肌腱断端缝合重建,Ⅰ期修复创面.受伤至手术时间1.0～4.5 h(平均2.5 h),皮肤软组织缺损范围1.5 cm×3.0 cm～3.0 cm×6.5 cm,所有患指均有伸肌腱缺损或伴一侧动脉节段性缺损.皮瓣切取范围为2.0 cm×3.5 cm～3.5 cm×7.0 cm.供区直接拉拢缝合.结果 术后8例皮瓣全部成活,6例皮瓣未出现明显水疱,色泽质地接近受区皮肤;1例皮瓣出现散在细小水疱,1例皮瓣远端及边缘瘀血,经换药后脱痂愈合.患者随访时间2～26个月,平均8个月.皮瓣质地柔软,外观稍臃肿,皮色略深于手指正常皮肤,皮瓣两点辨别觉为10～13 mm,平均11 mm,伸指功能恢复接近正常.按照中华医学会手外科学会肌腱修复后评定标准评定,优5例,良3例.结论 应用带掌长肌腱动脉化静脉皮瓣修复手指背侧复合组织缺损,具有切取方便、不牺牲主要血管、供区直接缝合,同时解决肌腱、动脉及皮肤复合缺损创面等优点,术后患指外观满意,功能恢复好,适用Ⅰ期修复手指背侧复合组织缺损.%Objective To explore the clinical application and clinical effect of repairing the compound tissue defects on dorsal side of the finger by an arterialized vein flap by a metacarpal long tendon. Methods From May 2012 to August 2017, 8 patients with finger dorsal compound tissue defects received the repairing with an arterialized vein flap of a metacarpal long tendon. The flap was grafted anterogradely and the internal vein was anastomosed with the finger arteriyl and vein. The grafting metacarpal long tendon was sutured with ruptured tendon. The interval from being injured to receiving surgery was 1 to 4.5 hours (averages 2.5 hours). The area of defected skin soft tissue was ranged from 1.5 cm×3.0 cm to 3.0 cm×6.5 cm. All patients had exten sor tendon defects or unilateral arterial segmental defects. The graft flap ranged from 2 cm× 3 cm to 3 cm× 7 cm and the supply area was stitched directly. Results After surgeries, all of the 8 grafted flaps kept alive, and there was no visible blister in 6 cases of them, of which the color and texture was similar to the transplanted area. The formation of small blister was present in 1 case. Extravasated blood was observed in the distal end and the edge of the flap in 1 case, and healed well after dressings. The patients were followed up for 2 months to 26 months, with an average of 8 months. The flaps were soft and slightly puffy, and the skin was slightly darker than the normal skin of the fingers. The length of sense point of the flap was 10 mm to 13 mm, and averaged 11 mm. The function of straightening fingers was basically normal, which ranked as the level of Excellent in 5 cases, and level of good in 3 cases, according to the Restored Function Criterion of Hand Surgery Association of CMA. Conclusion This approach is convenient to perform in clinical cases, which can avoid the injury of main blood vessels and offer direct suturing of the grafted area. It may settle the repairing of the tendon, artery and defected skin at the same time. The appearance of rehabilitated fingers is satisfactory and the finger function returns to normal after surgery. It is an appropriate treating method in the first stage of finger dorsal compound tissue defect.