不吻合静脉的微型游离复合组织瓣修复手指软组织缺损

目的 研究应用不吻合静脉的微型游离复合组织瓣修复手指软组织缺损.方法 根据手指不同部位组织缺损及面积（2.5cm×3.0cm～4.0cm×7.0cm）,对指腹缺损采用？？趾外侧皮瓣或足内侧皮瓣;指背缺损采用游离前臂背侧皮瓣,除？？趾外侧皮瓣带神经与受区相应神经接合外其余均不带神经.术后每2小时行侧切口或皮缘放血一次,3天后根据皮瓣颜色延长间隔时间,间断放血,4～5天后停止放血.结果 皮瓣完全成活14例,部分成活1例,坏死1例,成活皮瓣质地弹性颜色均正常.随访14例,失访1例.随访时间2～45个月,平均20.5个月,其手指功能,疼、触、温觉明显改善,2年后接近正常.按照中华医学会手外科学会功能评定标准：优12例,良1例,差1例,优良率92%.结论 采用不吻合静脉的微型游离组织瓣修复手指缺损,手术简单易行,疗效满意.

Reconstruction of the soft tissue defects of the fingers using the free mini composite flaps without venous anastomosis

Objective To study reconstruction of the soft tissue defects of the finers using the free mini composite flaps without venous anastomosis. Methods Based on the location of the defects in fingers and the area （ranged 2.5cm×3.0cm to 4.0cm×7.0cm）. Applying the lateral flap in the great toe and medial pedal flap to repair the defects of the finger pulps. And the defects at the dorsum of the fingers by freeing dorsal forearm flap. Only the nerve of the lateral flap in toe was anastonosis with that of the recipient sites. Others flaps didn＇t carry cutanoeus nerve. Esternal bleeding was applied after operation every 2 hours. Constant external bleeding was done 3 days postoperatively according to the flap color, and stopped after 4 to 5 days. Results The flaps in 14 cases was survival completely, and part survival in 1 case, necrosis in 1 cases. 14 patients was followed up from 2 to 45 months, with an average of 20.5 months. The appearance and function of hand and the sensation of flap such as pain, touch, temperiture, clour of skin improved obviously. All these closed to normal 2 years postoperatively. According to Association of Chinese medcine hand functional assessment standard： excellent in 12 cases, good in t case and poor in 1 case. The overall excellent and good rate was 92%. Conclusion It is simple and easy by using the free mini composite flaps without venous anastomosis to repair the defect worth of development and using. of the finger. The clinical outcomes is stisfactory, it isworth of development and using.