前臂中段尺动脉穿支游离皮瓣修复指端软组织缺损

目的 探讨前臂中段尺动脉穿支游离皮瓣修复指端缺损的临床效果和应用体会.方法 在前臂尺侧近前臂中段,以豌豆骨与肱骨内上髁的连线为皮瓣轴线,沿轴线在肱骨内上髁下方约9～10 cm处,以多普勒血流探测仪探及穿支血管穿出点,以此为皮瓣中心点设计游离皮瓣,皮瓣中带入穿支动、静脉和皮肤浅静脉,修复指端缺损,供瓣区直接缝合.皮瓣未吻合皮神经.结果 2005年6月至2009年6月,于临床应用12例,术后所有皮瓣成活,色泽、质地良好,无坏死发生,手指外形满意.术后对12例患者进行了6～36个月的随访,手指恢复良好.皮瓣感觉均有不同程度地恢复,两点辨别觉为6～12 mm,无畏寒、疼痛及敏感等异常感觉发生,供区外观良好.结论 前臂中段非掩盖部尺动脉可以提供稳定的穿支蒂皮瓣,皮瓣外形设计灵活,修复效果良好,符合"受区修复重建好,供区创伤损失小"的皮瓣修复原则.

Reconstruction of phalangeal defect with free mesio-forearm flap based on perforator of ulnar artery

Objective To discuss the therapeutic effect and clinical experience of a new technique of digital reconstruction with the free mesio-forearm flap based on perforator of ulnar artery. Methods We marked the line from the pisiformis to the condylus medialis humeri as the axis of the flap. We used Doppler to detect the site of the mesio-forearm ulnar perforator which is usually 9-10 cm proximal to the condylus medialis humeri as center of the flap. We designed the flap that contained perforator artery with its accompanying vein of the ulnar artery and a superficial vein around the center spot along the axis of ulnar artery. The wound at donor site was sutured directly. Neurorrhaphy was not conducted in any cases.Results From June 2005 to June 2009, all 12 flaps survived with good quality and aesthetic contour.And no necrosis occurred. We conducted 6-36 months follow-up, and the result was satisfactory. The function of the fingers was reserved. Tow-point discrimination differed from 6 cm to 12 cm. Conclusions The free ulnar perforator flap on mesio-forearm can repair digital defect with good therapeutic effect, leaving less morbidity at donor site.