摘要
目的 探讨桡神经浅支营养血管供血的示指近节背侧岛状皮瓣修复拇指皮肤软组织缺损的方法及疗效。方法 2019年8月—2024年12月,收治12例外伤致拇指皮肤软组织缺损伴第1掌背动脉变异患者。男8例,女4例;年龄19~55岁,平均32岁。创面范围2.2 cm×2.0 cm~5.5 cm×3.5 cm。受伤至手术时间1.5~6.0 h,平均4.5 h。创面彻底清创后,采用桡神经浅支营养血管供血的示指近节背侧岛状皮瓣修复,皮瓣切取范围2.4 cm×2.2 cm~6.0 cm×4.0 cm。皮瓣供区游离植皮修复。术后定期随访,观察皮瓣外观、质地、感觉恢复及供区情况。结果 手术时间30~72 min,平均47 min;术中出血量30~70 mL,平均46 mL。术后1例手背桡侧切口皮缘出现部分坏死,经换药后愈合;其余皮瓣均顺利成活,创面Ⅰ期愈合。供区植皮均成活。12例均获随访,随访时间5~36个月,平均14个月。皮瓣外观、弹性良好,末次随访时皮瓣两点辨别觉4~9 mm,平均5.2 mm;根据中华医学会手外科学会上肢部分功能评定试用标准评价,获优11例、良1例。皮瓣供区未见瘢痕挛缩,无疼痛及关节活动受限。结论 对于第1掌背动脉变异的拇指皮肤软组织缺损患者,可选择桡神经浅支营养血管供血的示指近节背侧岛状皮瓣修复,具有手术时间短、术中出血较少以及术后皮瓣外观、感觉良好等优点。
Objective To explore the method and effectiveness of index finger proximal dorsal island flap supplied by the nutrient vessels of superficial branch of radial nerve for treatment of thumb skin and soft tissue defect.Methods Between August 2019 and December 2024,12 patients with thumb skin and soft tissue defects caused by trauma accompanied by variation of the first dorsal metacarpal artery were treated.There were 8 males and 4 females,aged 19-55 years,with an average age of 32 years.The wound area ranged from 2.2 cm×2.0 cm to 5.5 cm×3.5 cm.The time from injury to operation ranged from 1.5 to 6.0 hours,with an average of 4.5 hours.After thorough debridement,the wound was repaired with a index finger proximal dorsal island flap supplied by the nutrient vessels of the superficial branch of the radial nerve.The flap area ranged from 2.4 cm×2.2 cm to 6.0 cm×4.0 cm.The donor site was repaired with free skin grafting.Regular follow-up was conducted postoperatively to observe the appearance,texture,sensory recovery of the flap,and the condition of the donor site.Results The operation time ranged from 30 to 72 minutes,with an average of 47 minutes;intraoperative blood loss ranged from 30 to 70 mL,with an average of 46 mL.After operation,partial necrosis occurred at the skin edge of the radial incision on the dorsum of the hand in 1 case,which healed after dressing changes;all other flaps survived uneventfully,with primary wound healing.The skin grafts at the donor sites all survived.All 12 patients were followed up 5-36 months,with an average of 14 months.The appearance and texture of the flaps were good.At last follow-up,the two-point discrimination of the flaps ranged from 4 to 9 mm,with an average of 5.2 mm.According to the functional evaluation criteria for upper limb issued by the Hand Surgery Society of Chinese Medical Association,the results were excellent in 11 cases and good in 1 case.No scar contracture,pain,or joint movement limitation was observed at the donor sites. Conclusion For patients with skin and soft tissue defects of thethumb accompanied by variation of the first dorsal metacarpal artery, the index finger proximal dorsal island flap suppliedby the nutrient vessels of the superficial branch of the radial nerve can be selected. This method has advantages such asshorter operation time, less intraoperative bleeding, and good postoperative appearance and sensation of the flap.
作者
杨焕友
张会文
部文茜
王伟
张荐
王斌
YANG Huanyou;ZHANG Huiwen;BU Wenqian;WANG Wei;ZHANG Jian;WANG Bin(Department of Hand Surgery,the Second Hospital of Tangshan,Tangshan Hebei,063000,P.R.China)
出处
《中国修复重建外科杂志》
北大核心
2025年第7期869-872,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
拇指
软组织缺损
岛状皮瓣
桡神经浅支营养血管
创面修复
Thumb
soft tissue defect
island flap
nutrient vessels of superficial branch of radial nerve
wound repair
