第二指蹼分叶岛状皮瓣急诊修复拇指脱套伤

1993年以来,根据第1、2掌背动脉血供特点,设计以这二条动脉为血管蒂的第2指蹼分叶岛状皮瓣修复拇指脱套伤5例。皮瓣大小3cm×6cm～6cm×7cm,结果全部成活,伤口一期愈合,术后随访3～9月,皮瓣质薄,有感觉,拇指活动、外形良好。认为此皮瓣对拇指脱套伤的修复很有实用价值。     

第二指蹼分叶岛状皮瓣包裹修复再造拇指

１９９３年３月以来，对拇措脱套伤及无再植条件的拇指断指，应用以第一、二掌背动脉为双蒂的第二指蹼分叶岛状皮瓣包裹修复，再造拇指６例，取得成功。该皮瓣适应于拇指掌措关节水平以远的皮肤脱套伤或拇缺损Ⅳ型的重建。皮瓣具有质薄柔软，颜色接近，有神经感觉（两点分辨觉８～１５ｍｍ），供区损伤小，操作简便，病人痛苦小等优点，对不愿做甲瓣移植又无条件做其他岛状皮瓣修复的拇损伤乃不失为一种良好术式。     

第二指噗分叶岛状皮瓣包裹修复再造拇指

１９９３年３月以来，对拇指脱套伤及无再植条件的拇指数指，应用以第一、二掌背动脉为双蒂的的第二指蹼分叶岛状皮瓣包裹修复，再造拇指６例，取得成功。该皮瓣适应于拇指掌指关节水平以远的皮肤脱套伤或拇缺损Ⅳ型的重建。皮瓣具有质薄柔软，颜色接近，有神经感觉，供区损伤小，操作简便，病人痛苦小等优点，对不愿做拇甲瓣移植又条件做其他岛状皮瓣修复的拇损伤乃不失为一种良好术式。     

指动脉Y形分叶岛状皮瓣治疗手指末节脱套伤

目的 报道手指Y形分叶皮瓣治疗手指末节脱套伤的方法和临床效果. 方法 对末节脱套伤32例33指,采用逆行指动脉背侧支Y形分叶皮瓣修复,其中示指16指,中指13指,环指3指,小指1指,缺损平面均在远指间关节以远.急诊手术30指,末节皮肤坏死二期手术3指. 结果 32例33指皮瓣全部成活,经5个月到27个月随访,外形、感觉和功能恢复满意. 结论 指动脉背侧支Y形分叶皮瓣治疗手指末节脱套伤,手术简便、安全,疗程短,是一种较为实用的方法.     

掌背动脉逆行岛状皮瓣瓦合修复中环指脱套伤

目的:寻求修复中、环指脱套伤的新方法。方法:选择8只新鲜的成人手标本灌注红色乳胶后在显微镜下解剖观察第二、三、四掌背动脉的分支及吻合情况。结果:血液供应主要依靠各掌背动脉在远、近侧轴点处发出的粗大皮支,皮支之间在筋膜层构成丰富的网状血管结构,在指蹼处与指掌侧总动脉或分支之间有恒定的吻合支。设计以此吻合支为蒂两个逆行岛状皮瓣瓦合修复中、环指脱套伤,临床应用8例,获得了满意效果。结论:此皮瓣质地好,血供恒定,适宜于修复中、环指脱套伤。     

第二掌背动脉终末支双“n”形皮瓣修复拇指末节脱套伤

目的 探讨第二掌背动脉终末支双“n”形皮瓣修复拇指末节脱套伤皮肤缺损的手术方法和临床效果. 方法 对16例拇指末节脱套伤皮肤缺损患者应用携带指背神经的第二掌背动脉终末支双“n”形皮瓣修复,并重建末节感觉.右手10指,左手6指.脱套拇指末节长度1.2～2.8 cm. 结果 16例皮瓣全部成活,15例获得随访,随访时间6 ～35个月,平均16.3个月.皮瓣质地柔软,外观满意,皮肤弹性好,拇指功能及外观恢复满意.指腹皮瓣的两点辨别觉达6 ～9 mm,平均8.1 mm,背侧皮瓣两点辨别觉达8～12 mm,平均10.2 mm.供区无瘢痕挛缩及感觉障碍等并发症.手功能按手指总主动活动度(TAM)法评定,优良率达93.3％. 结论 第二掌背动脉终末支双“n”形皮瓣携带指背神经修复拇指末节脱套伤,能同时完成皮肤覆盖和感觉重建,术后效果满意,是治疗拇指末节脱套伤较为理想的方法.     

掌背皮瓣和邻指动脉皮瓣修复单个全手指脱套伤

我科自1998～2003年采用掌背皮瓣和邻指动脉皮瓣对2～4指皮肤脱套伤行一期修复53例,不但恢复了良好的功能,而且感觉及外形恢复较好。1资料与方法1.1一般资料本组53例,男45例,女8例;年龄18～42岁。伤因:机器挤压伤18例,绳勒伤16例,重物砸伤11例,其他8例。部位:示指21例,中指11例     

掌背动脉及指动脉岛状皮瓣瓦合修复单指皮肤脱套伤

单指皮肤脱套伤是比较常见的手外伤，常规处理方法颇多，如远位带蒂皮瓣修复等，但术后功能的恢复往往不太理想。１９９６年４月～１９９８年２月，我们应用掌背动脉岛状皮瓣、指动脉岛状皮瓣一期瓦合修复单指皮肤脱套伤９例９指，皮瓣全部成活，疗效满意。一、资料与方法...     

示指和中指近节背侧岛状皮瓣修复拇指脱套伤

我们在2000年9月-2002年12月采用第一、二掌背动脉为蒂的示、中指近节背侧岛状皮瓣急诊一期修复拇指损伤9例10指，皮瓣均成活，效果满意。     

First dorsal metacarpal artery islanded flap: A useful flap for reconstruction of thumb pulp defects

Thumb pulp defects are commonly due to avulsion injuries. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. A very good option for coverage of these defects is the islanded first dorsal metacarpal artery flap. Our study was done over a period of 2 years and involved 9 consecutive cases of thumb pulp defects treated at our institution. The patients included 8 males and 1 female, ranging in age from 16 to 51 years old. The flap size ranged from 2 × 1.5 cm to 5 × 3 cm. We had only one complication in the form of partial flap necrosis, which fortunately healed following debridement without the need for a secondary procedure. All our cases were done under local anesthesia with tourniquet control. All the patients had good fine touch and average two-point discrimination of 6 mm, which was satisfactory. Our good results further reinforce the islanded first dorsal metacarpal artery flap as one the best flaps for sensate reconstruction of thumb pulp defects. It replaces the soft tissue loss at the thumb pulp with minimal donor site morbidity and with good return of thumb pulp sensation.     

Correction of thumb deformities after burn: versatility of first dorsal metacarpal artery flap

In the management of a debilitated burned hand due to contractures, thumb reconstruction constitutes the most crucial part for a beneficial functional outcome. Among the limited local flap alternatives for the thumb, the first dorsal metacarpal artery flap, harvested from the dorsal aspect of the index finger can provide elastic, durable and sensate coverage for soft tissue defects after contracture release. In a 3-year period, neurovascular island first dorsal metacarpal artery flap was used in 14 patients suffering thumb deformities. The time elapsed after the underlying injury until reconstruction ranged from 5 months to 17 years. Follow-up revealed that all deformities were successfully treated with satisfactory functional recovery and cosmetic results. Donor site morbidity was minimal with an acceptable scar on the dorsum of the index finger and adequate tendon gliding without producing extension deficit. Our experience with management of deformities involving the thumb and/or adjacent thenar area revealed that the first dorsal metacarpal artery flap is a reliable local neurovascular island flap option, offering acceptable functional and cosmetic outcomes in respect to sensation, elasticity, durability and skin-match.     

第1掌背动脉皮瓣一期修复儿童拇指软组织缺损

目的探讨第1掌背动脉皮瓣一期顺行修复儿童拇指软组织缺损的临床效果。方法选取自2009-06—2012—06收治的拇指皮肤组织缺损息儿11例,行急诊清创、残端修整及伴肌腱断裂的修补,骨折患者给予克氏针内固定,11例均予一期第1掌背动脉皮瓣修复拇指组织缺损。结果术后组织瓣全部成活,供区、受区伤口均一期愈合,质地与色泽较好。随访时间为3。24个月,平均10个月,无继发性感染发生,感觉恢复S3一S4,肢体外形与功能满意。结论儿童拇指软组织缺损应用第1掌背动脉皮瓣移植修复、重建软组织,可以避免儿童患拇指功能障碍。采用该皮瓣技术血供可靠、操作简单,是一期修复儿童拇指皮肤缺损理想的治疗方法。     

第一掌背动脉皮瓣修复拇、食指皮肤软组织缺损

目的报道第一掌背动脉皮瓣修复拇、食指皮肤软组织缺损的临床效果。方法2005年8月-2012年10月,采用第一掌背动脉皮瓣修复拇、食指皮肤软组织缺损35例,术后随访3-24个月。结果本组35例皮瓣成活良好,外观满意,两点辨别觉达6-10mm,无虎口挛缩,拇食指的对捏、对掌功能恢复良好。结论第一掌背动脉皮瓣修复拇、食指皮肤软组织缺损操作简单,供血血管变异率低,无需再次手术断蒂,也可制成带血运的掌骨、伸肌腱复合组织瓣,且能携带掌背皮神经重建感觉,值得临床推广。     

第二掌背动脉岛状皮瓣的临床应用

目的：通过解剖学研究，设计第２掌背动脉岛状皮瓣，临床修复手部皮肤缺损，获得成功。方法：对５０只经动脉灌注红色乳胶的成人手标本，在放大镜下观察第２掌背动脉及伴行静脉的起端，皮支、终末支的走行；测量血管各部位的直径。结果：第２掌背动脉终末支分布于第２指蹼、示中指近节皮肤；皮支和其它掌背、掌指动脉间有丰富的吻合支。临床应用８例，顺行皮瓣７例，逆行１例。修复手背、拇指皮肤缺损，皮瓣全部成活。结论：临床应用第２掌背动脉为蒂的岛状皮瓣时，可设计成顺行或逆行皮瓣，均能成活。     

First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study

Extensive pulp (zone 4) defects of the thumb, with the exposure of tendon or bone, are challenging reconstructive problems. Surgical treatment includes the use of local, regional, and free flaps. The first dorsal metacarpal artery flap has been used successfully for defects of the thumb. The innerved first dorsal metacarpal artery flap from the dorsum of the index finger was first described by Hilgenfeldt and refined by Holevich. An island flap carried on a neurovascular pedicle consisting of the first dorsal metacarpal artery was first demonstrated by Foucher and Braun. Seven innervated FDMCA island flaps were performed from May 2005 until July 2007 for thumb reconstruction. There were three women and four men with an average age of 54.9 years (range 28–89 years). The mean follow-up period was 15.4 months (range 4–29 months). The dominant hand was involved in six (85.7%) patients. In a retrospective clinical study, the following criteria were evaluated: (1) etiology of the defect, (2) time of reconstruction (primary vs. delayed), (3) survival rate of flap, (4) sensory function (Semmes–Weinstein monofilaments, static 2-PD, pain, cortical reorientation), (5) TAM measured with the Kapandji index, and (6) subjective patient satisfaction (SF 36). Four patients presented with trauma, two patients with defects after tumor resection and one with infection of the thumb. The flap was used for immediate reconstruction in three (42.9%) patients and for delayed reconstruction in four (57.1%) patients. Delayed reconstruction was performed 4.75 (1–12) months after initial trauma or first surgery. The donor area was grafted with full-thickness skin grafts in all cases. All flaps survived. The mean SWMF was 3.31 g and average statis 2-PD over the flap was 10.57 mm. Pain at the flap scored 3.71 over 10 and at the donor site 2.17 over 10. Paresthesia at the flap scored 0.57 over 4 and at the donor site 0.33 over 4. Complete cortical reorientation was only seen in one patient. The mean Kapandji score of the reconstructed thumb was 7.43 over 10. Using the SF-36, mean physical health of the patients scored 66.88% and mean mental health scored 70.55%. Disturbing pain and paresthesia of the flap are exceptional. The static 2-PD is more than 10 mm, and is clinically over the limit. Cortical reorientation was incomplete in all but one patient. Touch on thumb is felt on the dorsum of the index finger; however, sensation is not disturbing or interfering with the patient’s activities. Foucher described the technique débranchement–rébranchement in order to improve this problem. The postoperative total amount of motion of the reconstructed thumb was very good. The results demonstrated that the FDMCA flap has a constant anatomy and easy dissection. It has a low donor site morbidity if FTSG is used. It also shows good functional and aesthetic results. Therefore, the FDMCA flap is a first treatment of choice for defects of the proximal phalanx and proximal part of the distal phalanx of the thumb.     

(踇)甲瓣联合第二趾胫侧皮瓣修复拇指及虎口区皮肤缺损

目的 报道13例(踇)趾甲瓣联合第二趾胫侧皮瓣修复拇指及虎口皮肤缺损的临床效果.方法 2003～2007年间应用躅趾甲瓣联合第二趾胫侧皮瓣修复13例拇指及虎口皮肤缺损,其中2例为全手皮肤脱套伤.根据动脉的Gilbert分型采取不同的切取方式,2个组织瓣的神经应分别与受区相应神经吻合.结果 术后再造指及皮瓣全部成活,受区创面全部一期愈合.术后9例获得随访,平均随访时间7个月.再造指及皮瓣色泽与正常拇指相近.1年以上随访病例感觉恢复好,痛触温觉敏感,两点辨别觉为7～17 mm.拇指外展60°～85°,平均75°.拇指功能好,患者能恢复正常工作生活.结论 将拇指和虎口作为一个整体进行修复.应用(踇)趾甲瓣联合第二趾胫侧皮瓣修复拇指合并虎口区皮肤缺损是一种有效的修复方法,有利于手功能的恢复.     

Hourglass dorsal metacarpal island flap: a new design for syndactylized web reconstruction

Web space reconstruction is the key point and an important component of syndactyly treatment. A design of the dorsal metacarpal artery flap was used as an island flap based on the direct cutaneous branch arising from the dorsal metacarpal artery at the distal end of the flap to reconstruct congenital web syndactyly. The flap rotated from 0 degrees to 180 degrees and passed under a skin bridge at the distal end of the flap to reach the web defect. Such design enables a better use of the skin territory from the intermetacarpal space proximal to the pedicle, with a short donor site scar and a more supple reconstruction of the web space.