摘要
目的探讨桡动脉鼻烟窝穿支筋膜皮瓣修复手部大鱼际及拇指背侧较大面积软组织缺损的临床疗效。方法2012年6月至2017年3月,唐山市第二医院收治的18例手部大鱼际及拇指背侧较大面积软组织缺损患者,其中男13例,女5例,年龄17~64岁,平均39岁。右侧14例,左侧4例。大鱼际部缺损5例,拇指背侧缺损7例,大鱼际合并拇指背侧缺损6例。18例创面均存在肌腱和(或)骨外露。清创后创面缺损大小:2.5 cm×3.5 cm^4.5 cm×6.0 cm。以鼻烟窝为旋转点、桡骨茎突至桡骨小头的连线为轴线设计切取桡动脉鼻烟窝穿支筋膜皮瓣,转位修复。4例拇指背侧伸肌腱缺损无法直接缝合患者,取同侧肱桡肌部分肌腱桥接移植修复。皮瓣面积:2.8 cm×3.8 cm^5.0 cm×6.8 cm。术后观察皮瓣血运、外观,评价患侧拇指屈、伸总活动度(TAM)、虎口角及患者满意度。结果术后18例皮瓣全部成活,前臂供区16例直接闭合,2例残留创面行游离皮片移植修复。所有病例均获得8~16个月随访,平均12个月。皮瓣外形美观,不臃肿,色泽及质地良好。患侧拇指TAM平均值为139°,优15例,良3例。虎口角平均值为96°,均为优。患者对皮瓣外形及拇指功能满意度:非常满意10例,满意8例。结论桡动脉鼻烟窝穿支筋膜皮瓣解剖恒定、操作简单、供区损伤小,对修复手部大鱼际及拇指背侧较大面积软组织缺损,特别是合并拇指伸肌腱缺损的创面,是一种较理想的方法。
Objective To investigate the clinical outcomes of snuffbox perforator flap of radial artery to repair large soft tissue defects of the thenar and dorsal thumb.Methods From June 2012 to March 2017,a total of 18 cases with large soft tissue defects of the thenar and dorsal thumb were hospitalized in the Second Hospital of Tangshan.There were 13 males and 5 females,with an average age of 39 years(range,17 to 64 years).The right hand was involved in 14 cases and the left in 4 cases.There were 5 cases of thenar defect,7 cases of dorsal thumb defect and 6 cases of thenar combined with dorsal thumb defect.The tendon and/or bone were exposed in all 18 cases.The size of the wounds after debridement ranged from 2.5 cm×3.5 cm to 4.5 cm×6.0 cm.The snuffbox perforator flap was designed to repair the defect based on the pivot point of snuff box and the axis line from styloid process of radius to capitulum of radius.Four cases with extensor tendon defects of the thumbs were grafted with a section of brachial radial tendon.The dimension of the flaps ranged from 2.8 cm×3.8 cm to 5.0 cm×6.8 cm.The observation indexes included blood supply and appearance of the flap,the total activity of flexion and extension(TAM)of the injured thumb,the angle of the first web span and the satisfaction of the patients.Results All flaps survived uneventfully.The donor area of forearm was directly closed in 16 cases,and the remaining wound in 2 cases was repaired by free skin graft.All the cases were followed up for 8 to 16 months(mean,12 months).The good appearance of the flaps with soft texture was obtained.The average values of TAM of the injured thumbs and the first webs were 139°and 96°,respectively.They were excellent in 15 cases and good in three cases for TAM,and excellent in all cases for the first webs.10 patients were very satisfactory with flap appearance and thumb function and the rest was satisfactory.Conclusions The snuffbox perforator flap of radial artery provides a reliable and simple technique with constant blood supply and minimal donor-site cost,which could be an ideal option for repairing large soft tissue defects of the thenar and dorsal thumb with extensor tendon defects of the thumbs.
作者
王辉
杨晓溪
霍永鑫
李军
王伟
刘伟
王斌
Wang Hui;Yang Xiaoxi;Huo Yongxin;Li Jun;Wang Wei;Liu Wei;Wang Bin(Department of Hand Surgery,the Second Hospital of Tangshan,Tangshan 063000,China;Clinical Department of Traditional Chinese Medicine,the College of Traditional Chinese Medicine,North China University of Science and Technology,Tangshan 063000,China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2019年第12期1226-1229,共4页
Chinese Journal of Plastic Surgery
关键词
外科皮瓣
大鱼际
拇指
创面修复
Surgical flap
The thenar
Thumb
Wound repairing
