改良带蒂旋髂浅动脉皮瓣修复手部及前臂创面

目的探讨改良带蒂旋髂浅动脉皮瓣修复手部及前臂大面积皮肤软组织缺损的疗效。方法 2008年6月-2011年6月,收治13例手部及前臂大面积皮肤软组织缺损患者。男9例,女4例;年龄23～64岁,平均41岁。致伤原因:机器绞轧伤2例,钢绳轧伤4例,交通事故伤3例,重物压伤2例,高压电击伤1例,蛇咬伤1例。新鲜创面10例,感染坏死创面3例。创面均伴骨及肌腱外露,皮肤软组织缺损范围为7 cm×3 cm～22 cm×6 cm。8例采用带蒂旋髂浅动脉皮瓣修复,5例采用带蒂旋髂浅动脉复合组织瓣修复。术中切取皮瓣蒂部携带2～4 cm宽皮条及3～5 cm宽软组织筋膜蒂;皮瓣切取范围为12 cm×4 cm～27 cm×8 cm。结果术后1周1例皮瓣部分撕脱出血,4周后断蒂;其余皮瓣均于术后3周断蒂;皮瓣均成活。供区切口Ⅰ期愈合。11例患者获随访,随访时间6～36个月,平均20个月。皮瓣色泽、质地好;其中3例皮瓣外形较臃肿,于术后3～6个月行皮瓣修薄术后外形满意。术后6个月皮瓣均恢复保护性感觉。术后6个月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定手指总主动活动度(TAM),获优9例,良1例,差1例。结论改良蒂部的带蒂旋髂浅动脉皮瓣可修复手部及前臂大面积皮肤软组织缺损,且手术操作简便,供区损伤小。

IMPROVED PEDICLED SUPERFICIAL ILIAC CIRCUMFLEX ARTERY FLAP FOR RECONSTRUCTION OF HAND AND FOREARM WOUNDS

Objective To explore the effectiveness of the improved pedicled superficial iliac circumflex artery flap for repairing serious wound of the hand and forearm. Methods Between June 2008 and June 2011, 13 cases of serious wound of the hand and forearm were treated. There were 9 males and 4 females with a mean age of 41 years (range, 23-64 years). The disease causes included twist injury by machine in 2 cases, wire rope squeezed injury in 4 cases, traffic accident injury in 3 cases, crushing injury in 2 cases, high voltage electrical injury in 1 case, and snake bites in 1 case. There were 10 cases of fresh wounds and 3 cases of infection and necrosis wounds, and all had bone and tendon exposure. The skin and soft tissue defects ranged from 7 cm × 3 cm to 22 cm × 6 cm. The pedicled iliac artery flap was used in 8 cases, and pedicled iliac artery composite flap in 5 cases. The flap size ranged from 12 cm × 4 cm to 27 cm × 8 cm, with the flap pedicle of 2-4 cm wide strip and 3-5 cm wide fascia. Results The pedicle of flap was cut at 3 weeks in 12 patients, and at 4 weeks in 1 patient who had partial avulsion and hemorrhage at 1 week after operation. All flaps survived and incisions at donors and wounds healed by first intention. Eleven patients were followed up 6-36 months (mean, 20 months). The flap color and texture were good; 3 bulky flaps were observed, and satisfactory appearance was achieved after skin flap thinning. After 6 months, the protective sensation recovered in all cases; according to the Hand Surgery Society of Chinese Medical Association evaluation of upper extremity function trial standard for total active motion of the fingers, the results were excellent in 9 cases, good in 1 case, and poor in 1 case. Conclusion Improved fascia pedicled superficial iliac circumflex artery skin flap can repair serious hand and forearm injury, which is easy-to-operate and less injury at donor site.