探讨前臂静脉皮瓣在断指再植中的应用设计

目的探讨38例需结合前臂静脉皮瓣进行断指再植的应用设计。方法对38例合并皮肤缺损的断指应用游离前臂静脉皮瓣桥接再植，根据皮肤或血管的缺损情况，设计相应的前臂静脉皮瓣，通过吻合血管的方法游离移植皮瓣恢复断指血运的同时修复缺损创面，同时使前臂创伤最少。结果38例断指全部成活．其中3例静脉皮瓣出现小部分坏死，余均一期愈合，术后随访3-20个月，皮瓣及手指的感觉均在半年后部分恢复，甚至个别恢复良好。结论前臂皮瓣应用于组织缺损的断指再植是可行的，合理的皮瓣设计，有利于断指创面的修复及供区的闭合，反之会增加手术的困难，甚至影响手术的成败。

Forearm venous flap in finger replantation design and discussion

Objective To analyze the process and outcomes of 38 cases of severed fingers with tissue defect, in which forearm venous flaps were adopted in replantation. Methods In 38 cases of severed finger with skin defect, free forearm venous flaps were adopted as a bridge in Replantation. According to the various degrees of skin or vascular defects, corresponding forearm venous flaps were designed to repair the defects throuogh vascular anastomosis, while restoring blood supply of the fingers and minimizing the forearm damage. Results All the 38 cases of replantation survived. Small parts of necrosis in venous flap appeared in 3 cases. The others were primary healing. In the postoperative follow-up ranged from 3 to 20 months, all cases got partial sensory recovery in flap and finger after half a year, while individual got good recovery. Conclusion The forearm venous flap is feasible in finger replantation with tissue defect. Rational design will be conducive to the defect repair and the donor site closure. By contraries, irrational design will increase operation difficulty, or even lead to the failure of operation.