目的 观察保留桡神经浅支的血管筋膜蒂皮瓣进行转位修复手部创面的可行性及临床效果.方法 临床应用前臂远端保留桡神经浅支的血管筋膜蒂皮瓣修复手腕部软组织缺损7例,皮瓣切取面积7 cm×4 cm～12 cm×7 cm.结果 7例皮瓣中4例完全成活,3例出现静脉回流障碍,其中1例表皮脱落,皮瓣全部成活,质地良好；1例远端皮肤有宽约1.5cm坏死区,经植皮愈合;另1例皮瓣远端有3 cm×2 cm斑片状坏死,经换药瘢痕愈合.术后5例桡神经浅支支配区皮肤感觉正常；2例有麻木感,术后4周恢复正常.经术后3～20个月随访,7例患者对皮瓣修复效果均表示满意,2例对皮瓣部分坏死后的局限性瘢痕及前臂植皮瘢痕有整形愿望.结论 保留桡神经浅支的血管筋膜蒂皮瓣对保留手部皮肤感觉有实用价值,进一步改善静脉回流是防止皮瓣部分坏死的关键因素.%Objective To observe the retention radial nerve superficial branch vascular fasciocutaneous pedicle flap's feasibility, method, indication and clinical effect in hand trauma. Methods 7 patients with soft tissue defects in hand and wrist wound were treated with forearm retention radial nerve superficial branch vascular fasciocutaneous pedicle flap, the flap area was 7 cm×4 cm~12 cm×7 cm, and the clinical outcome were observed. Results The flaps in 4 cases survived successfully, however the other 3 cases developed venous flow obstruction: skin flap distal side had a necrotic area width of 1.5 cm in 1 case, and healed by skin grafting; 1/4 distal skin flap zone had patchy necrosis in 1 case, and healed with contractile scar; the epidermis of the flap was necrotic in 1 case, but the flap's appearance was good. The skin feeling was normal in the area, arranged by superficial branch of the radial nerve in 5 case; 2 cases had numbness, but the depth of pain feeling existed and recovered normal 4 weeks later. After 3~20 months following-up, all these 7 patients were satisfied with the skin flap treatment outcome. 2 patients wanted to do the plastic surgery, because of the forearm skin grafting scar. Conclusion It has practical value to protect hand skin feeling, that by using retention of the superficial branch of the radial nerve, but improving the venous return is the key factor of affecting survival of skin flap.
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