尺动脉腕上皮支逆行岛状皮瓣修复手部创面缺损的临床分析

目的 :探讨应用尺动脉腕上皮支皮瓣修复手部创伤后软组织缺损的临床疗效。方法 :自2010年6月至2016年11月采用尺动脉腕上皮支皮瓣逆行修复手部创伤后软组织缺损病例12例,男9例,女3例;年龄22~58(35.3±9.4)岁。创面软组织缺损大小12 cm×7 cm~7 cm×3 cm。伤后至手术时间3~15(8.4±2.6)d。根据创面缺损大小预先设计皮瓣,在深筋膜近端向远端锐性解剖,切断皮瓣与尺动脉间的交通达腕上皮支处,行皮瓣逆行转移修复缺损创面。观察皮瓣的感觉、外形及手部功能,并采用中华医学会上肢部分功能评定试用标准中上肢周围神经功能评定试用标准手功能评定部分评价功能的恢复情况。结果:10例皮瓣Ⅰ期愈合,愈合时间14~18(15.0±1.5)d;2例皮瓣远端部分坏死,经换药后植皮覆盖创面愈合。12例患者均获得随访,时间3~15(7.0±3.8)个月。手部功能采用中华医学会上肢部分功能评定试用标准中上肢周围神经功能评定试用标准手功能评定部分:优2例,良7例,可2例,差1例。结论:对于手部创伤后造成的软组织缺损,应用尺动脉腕上皮支逆行皮瓣具有供区隐蔽,不牺牲主干血管,皮瓣纤薄,不需要二次修薄等优势。

Clinical analysis of repairing the defect of hand with reverse island skin flap of upper carpal cutaneous branches of ulnar artery

Objective:To investigate the clinical effect of repairing soft tissue defect after hand wound using reverse island skin flap of upper carpal cutaneous branches of ulnar artery.Methods:From June 2010 to November 2016,12 patients with hand soft tissue defects were repaired by reverse island skin flap of upper carpal cutaneous branches of ulnar artery,including 9 males and 3 females with an average age of (35.2±9.4) years old ranging from 22 to 58 years. The defect area varied from 7.0 cm×3.0 cm to 12.0 cm×7.0 cm. Time interval from injury to operation ranged from 3 to 15 days with an average of (8.4±2.6) days. The flap was designed beforehand according to the size of the defect,sharply dissected the aponeurotic fascia from the proximal to the distal,abscised the communicating branch between the flap and the ulnar artery at the wrist epithelial branch,repairing the defect of flap with method of metastasis retrograde. The sensation,shape of the flap and hand function were observed,and the upper extremity function was evaluated according to the standard of hand surgery branch from Chinese Medical Association to assessment of functional recovery.Results:The flaps in 10 patients obtained primary healing,the healed time was 14 to 18 days with an average of(15.0±1.5) days. Two patients occurred distal flap necrosis,and wound surface healed after change dressing and skingrafting cover. All patients were followed up from 3 to 15 months with an average of(7.0±3.8) months. According to the upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association,2 cases got excellent results,7 good,2 fair and 1 poor.Conclusion:Reverse island skin flap of upper carpal cutaneous branches of ulnar artery for the treatment of soft tissue defect caused by hand wound has advantages of concealed donor area,no need sacrifice the main blood vessel,flap thin and no need repair it for thick and thin.