游离骨间背动脉穿支皮瓣修复手背侧皮肤软组织缺损

摘要

目的 探讨游离骨间背动脉穿支皮瓣修复手背侧皮肤软组织缺损的临床疗效.方法 2014年2月-2017年9月共治疗15例手背侧皮肤软组织缺损,缺损面积:2.5 cm×5.0 cm～4.5 cm×8.0 cm.手术均采用游离骨间背动脉穿支皮瓣修复缺损创面.修复指背侧12例,腕背部3例.皮瓣穿支动脉与指固有动脉或掌背动脉吻合,皮瓣伴行静脉与指背静脉或掌背静脉吻合.供区创面11例直接缝合,4例取髂腹股沟全厚皮片移植覆盖.结果 15例皮瓣均成活,1例术后10 d皮瓣远端皮缘逐渐发黑坏死,行扩创和换药治疗后治愈.术后随访6～19个月,平均13.8个月,皮瓣无臃肿,颜色、质地接近手背侧正常皮肤;根据2000年改进的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12例,良3例.手指神经损伤修复后两点辨别觉10～14 mm.结论 游离骨间背动脉穿支皮瓣颜色、质地与手背侧皮肤接近,属同源皮瓣,切取皮瓣不会影响上肢主干血管,对供区损伤较小,皮瓣设计灵活,可根据损伤情况选择单穿支或多叶皮瓣,特别适用于修复手腕背部中小面积及手指背侧的皮肤软组织缺损.%Objective To investigate the clinical effect of free posterior interosseous artery perforator flap on the repair of skin and soft tissue defects on the dorsal side of hand. Methods From February 2014 to September 2017, 15 cases of skin and soft tissue defects on the dorsal side of hand were treated. The defect area was 2.5 cm×5.0 cm～4.5 cm×8.0 cm.The free posterior interosseous artery perforator flap was used to repair the defect.Repair of dorsal fingers in 12 cases, dorsal wrist in 3 cases.The perforating branches of the flap were anastomosed with the proper digital artery or the dorsal metacarpal artery, and the flap was anastomosed with the dorsal vein of the finger.Donor site's wounds were directly sutured in 11 cases, and 4 cases were covered with iliac inguinal full thickness skin graft. Results All 15 flaps survived, and 1 case developed black necrosis of the distal margin of the flap after 10 d. After 6～19 months of follow-up, an average of 13.8 months, the flap was not bulky, and its color and texture were close to the normal skin on the back of the hand; according to the evaluation criteria of the upper limb function evaluation of the hand surgery society of Chinese Medical Association, which was improved by Pan Shengde in 2000, 12 cases were excellent and 3 cases were good.Two point discrimination was 10 to 14 mm after suturing of the cutaneous nerve.Conclusion The color and texture of the free posterior interosseous artery perforator flap are close to the dorsal skin of hand, belongs to the homologous skin flap, and the skin flap will not affect the main vessels of the upper limb, the design of the skin flap is flexible熏and single perforator or multi-leaf flap can be selected according to the injury situation熏especially suitable for repairing the skin and soft tissue defects on the back of wrist and fingers.