第Ⅱ掌背动脉蒂掌背岛状皮瓣

介绍一种改良第Ⅱ掌背动脉皮瓣的新术式。方法　应用以第Ⅱ掌背动脉远端为蒂的旋转点的掌背岛状皮瓣,修复拇指创面７例,皮瓣面积１ｃｍ ×３ｃｍ～２ｃｍ ×４ｃｍ,血管蒂长６～７ｃｍ。结果 ７例皮瓣均成活,效果满意。结论当指背皮肤同时受损,而难以应用示、中指背岛状皮瓣时,可用此手部小型岛状皮瓣修复拇指创面。     

Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb

Finding an appropriate soft-tissue grafting material to close a wound located over the distal phalanx of the thumb, especially the pulp region, can be a difficult task. A sensate first dorsal metacarpal artery flap, mobilized from the dorsum of the adjacent index finger and used as an island pedicle skin flap, can be useful for this purpose. The pedicle includes the ulnar branch of the first dorsal metacarpal artery, the dorsal veins, and the cutaneous branch of the radial nerve. Although this tiny artery is anatomically variable, safe dissection can be achieved by including the radial shaft periosteum of the secondary metacarpal bone and the ulnar head fascia of the first interosseous muscle.This approach has been used for 8 individuals with extensive pulp defects of the thumb over the past 3 years. Skin defects in all patients were combined with bone, joint, or tendon exposure. All flaps survived completely. This 1-stage procedure is reliable and technically simple. It provides sensate coverage to the pulp of the thumb but also avoids nerve repair or more complicated microsurgery.     

Flap within a first dorsal metacarpal artery flap for recurrent thumb injury

Thumb pulp defects are commonly due to avulsion injuries. It is important to reconstruct these defects using sensate. A very good option for these defects is the islanded first dorsal metacarpal artery flap (FDMA). We present a patient, a carpenter by occupation, who had initial thumb pulp injury which was reconstructed with islanded first dorsal metacarpal artery flap. At 6-month follow-up, he had near normal sensation and two-point discrimination of 2 mm. The same patient represented after 1 year with similar injury to the same reconstructed thumb. This time, VY advancement flap was designed within the remnant of the previous FDMA flap. Flap within a flap is not a new concept. In the present scenario, it worked as a great indigenous solution as it was a simple alternative. It preserved the sensation and avoided the need of other complex reconstructions. The procedure was performed under local anaesthesia, and patient could return to his normal activities within 2 weeks post-op. This is a rare case report of making use of the concept of flap within a flap for recurrent thumb injury which was reconstructed previously with FDMA flap. VY advancement design aided the necessary movement required to cover the defect yet preserving the regained sensation making it a useful tool before embarking upon complex reconstructions.Level of Evidence: Level V, therapeutic study.     

手部神经血管蒂皮瓣的临床应用

我院自1962年5月至1992年1月,应用手部神经血管蒂皮瓣72例,其中指神经血管蒂皮瓣38例,示指背侧岛状皮瓣(第1掌骨背动脉)24例,手背第Ⅱ掌骨背动脉皮瓣7例,小鱼际皮瓣3例,修复手部皮肤缺损。术后除1例指神经血管蒂皮瓣失败外,余均成活,经1个月～12年随访功能优良率为94.4%。我们在文中介绍了各种皮瓣的优缺点,皮瓣设计,手术要点,并讨论了皮瓣的解剖学规律及手术适应证。     

带掌背浅静脉的第三掌背动脉岛状皮瓣

目的探讨带掌背浅静脉的第三掌背动脉逆行岛状皮瓣的手术方法,扩大第三掌背动脉皮瓣的修复范围,提高皮瓣的成活质量。方法通过皮瓣蒂部带第三掌背皮神经及掌背浅静脉,在原轴线近端距轴点6cm左右,以浅静脉为轴线向腕背部延伸,在此轴线上设计切取皮瓣。自1999年以来,修复中指、环指近、中节指背或指腹软组织缺损13例,其中合并远节指腹指背软组织缺损5例。结果皮瓣全部成活,2例类似于静脉皮瓣成活。结论本术式扩大了第三掌背动脉岛状皮瓣的修复范围,使之可修复中、环指的整个指背或指腹软组织缺损。该术式操作方便,效果较好,值得临床推广。     

手部神经血管蒂皮瓣的临床应用

我院自１９６２年５月至１９９２年１月，应用手部神经血管蒂皮瓣７２例，其中指神经血管蒂皮瓣３８例，示指背侧岛状皮瓣（第Ⅰ掌骨背动脉）２４例，手背第Ⅱ掌骨背动脉皮瓣７例，小鱼际皮瓣３例，修复手部皮肤缺损。术后除１例指神经血管蒂皮瓣失败外，余均成活，经１个月～１２年随访功能优良率为９４．４％。我们在文中介绍了各种皮瓣的优缺点，皮瓣设计，手术要点，并讨论了皮瓣的解剖学规律及手术适应证。     

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.     

封闭负压引流结合掌背动脉穿支皮瓣、掌长肌腱移植修复手背复合组织缺损

目的探讨封闭负压引流(VSD)技术结合逆行掌背动脉穿支岛状皮瓣、掌长肌腱移植修复手背复合组织缺损的临床疗效。方法应用VSD技术结合逆行掌背动脉穿支岛状皮瓣、掌长肌腱移植修复11例手背复合组织缺损患者。组织缺损面积1.8 cm×2.0 cm~3.0 cm×6.0 cm,切取皮瓣面积2.0 cm×2.5 cm~3.5 cm×7.0 cm。结果切取第2掌背动脉穿支岛状皮瓣7例,第3掌背动脉穿支岛状皮瓣2例,第4掌背动脉皮瓣皮支岛状皮瓣2例。皮瓣全部成活,无皮瓣感染病例。患者均获得随访,时间7~25个月。伤指关节功能、皮瓣外形较满意。末次随访时按手指总主动活动度(TAM)标准评估伤指功能:优6例,良3例,中2例。结论 VSD可有效控制创面炎症,结合逆行掌背动脉穿支岛状皮瓣、掌长肌腱移植修复手背复合组织缺损,外形及功能恢复满意、血运可靠,是一种较好的修复方法。     

桡动脉腕背分支为蒂的手背逆行岛状筋膜皮瓣的临床应用

目的探讨手背部桡动脉腕背分支为蒂的三种逆行岛状筋膜皮瓣的手术方法及临床应用。方法桡动脉在腕背鼻烟窝穿出,与尺动脉掌深弓吻合之前,发出腕背皮支、第1掌背动脉、拇指背侧支以三支动脉为蒂,形成逆行鼻烟窝皮瓣、第1掌背动脉皮瓣、拇指背侧动脉皮瓣,修复虎口挛缩和指、示指、腕掌、腕背侧皮肤缺损。结果切取桡动脉腕背皮支逆行岛状皮瓣13例,修复拇指、虎口、指、腕掌、腕背组织损伤及缺损。术后随访皮瓣外形及手功能恢复效果满意。结论桡动脉腕背分支行岛状筋膜皮瓣血运好,质地柔软,切取方便,不牺牲主要动脉,是修复手部皮肤缺损的一种简单安全、损伤小的方法。     

吻合神经的手部皮神经营养血管皮瓣修复指端软组织缺损

目的 报道应用吻合神经的手部皮神经营养血管皮瓣修复手指指端软组织缺损的临床效果.方法 采用掌背皮神经营养血管皮瓣掌侧移位修复拇指指端软组织缺损;拇指尺背侧皮神经营养血管皮瓣修复示指指端软组织缺损:中、环、小指指背皮神经营养血管皮瓣修复相应指端软组织缺损;共修复指端软组织缺损56例. 结果 皮瓣全部成活,随访6个月～3年,皮瓣质地柔软、弹性好、耐磨;指端饱满,色泽正常,两点辨别觉5.4～9.6 mm,45例感觉恢复至S3,11例至S4,外观及功能满意.结论 应用吻合神经的手部皮神经营养血管皮瓣修复手指指端软组织缺损,效果良好.     

缝合神经的掌骨背逆行筋膜蒂皮瓣修复逆行指动脉皮瓣术后供区皮肤缺损

目的：探讨采用缝合神经的掌骨背逆行筋膜蒂皮瓣修复逆行指动脉皮瓣切取后指神经裸露及软组织缺损的方法及疗效。方法应用缝合神经的掌骨背逆行筋膜蒂皮瓣修复逆行指动脉皮瓣移植后供区软组织缺损20例21指,软组织缺损面积：1.5 cm×2.0 cm～2.0 cm×3.0 cm。随访检测患指皮瓣外观、关节活动度及感觉等指标。结果术后20例皮瓣全部成活。术后经5个月随访,修复后患指指动脉皮瓣供区外形饱满,质地柔软,局部皮肤感觉及供区各关节活动范围令人满意。结论采用缝合神经的掌骨背逆行筋膜蒂皮瓣修复逆行指动脉皮瓣切取后供区指神经裸露及软组织缺损是有效而简单的方法,并可获得良好的外形及功能。     

第一掌背动脉皮瓣联合大鱼际皮瓣修复拇指末节皮肤脱套伤

【摘要】目的 探讨第1掌背动脉皮瓣联合大鱼际皮瓣修复拇指末节皮肤套脱伤的疗效。方法 2009年1月至2014年7月,我院对19例拇指末节皮肤套脱伤患者,创面缺损面积在20mm×50mm～30mm×60mm之间,拇指末节皮肤套脱合并甲床缺如13例,皮肤套脱伴甲床残留6例,均采用第1掌背动脉皮瓣联合大鱼际皮瓣进行修复,并观察术后19例拇指功能外形感觉等指标。 结果 本组12例皮瓣术后完全存活;5例术后2～4天皮瓣表面出现水疱,颜色暗红、发紫,间断拆除蒂部旋转点缝线后,皮瓣血运逐渐好转,最终存活良好;2例第1掌背动脉皮瓣尖端皮缘坏死,换药后痂下愈合,无骨外露,所有供区切口均1期愈合。经过3个月随访,手指皮瓣外形良好,指腹皮瓣感觉可,两点辨别觉6～9mm,指背皮瓣无感觉恢复;按照手指总主动活动度(TAM)法评定,优17指,良2指,优良率为100％,按照Michigan手外科问卷评定患者对拇指术后外观的满意度评定,非常满意15例,满意4例. 结论 该术式疗效满意,是治疗拇指末节皮肤套脱伤可行性的一种方法。     

游离指固有动脉背侧支皮瓣修复指腹缺损

目的 报告应用指固有动脉背侧支皮瓣游离移植修复指腹缺损的手术方法和临床效果.方法 对6例6指指腹缺损的患者,采用指固有动脉背侧支皮瓣游离移植修复,皮瓣切取面积为1.0cm×1.0cm～2.0 6m×2.5 cm,供区为患指或邻指的近节桡背或尺背侧,供区全部采用全厚皮片植皮.结果 术后6例皮瓣全部存活,随访时间6～18个月,平均12个月,皮瓣质地、外形满意,手指功能恢复优良,远指间关节活动度为0°～60°,皮瓣两点分辨觉为6～11mm.皮瓣供区创面Ⅰ期愈合,远期随访植皮区耐磨,无破溃发生,供区指体活动未受影响.结论 应用游离指固有动脉背侧支皮瓣修复指腹缺损,手术操作相对简单,修复后指腹饱满、外形逼真并具有感觉,是一种理想的手术方法.     

延长的指动脉逆行岛状皮瓣的临床研究

目的　探讨延长切取指动脉逆行岛状皮瓣的可行性和临床效果。方法　 2 0 0 1年以来 ,延长切取指动脉逆行岛状皮瓣修复指腹缺损 7例。结果　皮瓣全部成活 ,经随访 ,修复后指腹两点辨别觉为 6～ 9mm(平均为 7 6mm) ,外形满意 ,患者均恢复原工作。结论　延长切取指动脉逆行岛状皮瓣安全可行 ,是一种修复指腹大范围缺损的较理想方法。     

双轴点掌背皮动脉皮瓣修复腕手指软组织缺损

目的探讨应用双轴点掌背皮动脉皮瓣修复腕或手指软组织缺损的手术方法及其疗效. 方法 1995年～2003年,通过解剖学研究发现,由掌背动脉发出的近侧及远侧皮支在皮下组织内形成恒定的弓状动脉吻合,以其近侧或远侧皮支为蒂,手背皮肤为供区,可形成顺行或逆行岛状皮瓣.临床应用了27例,采用顺行修复手背3例,皮瓣范围2.0 cm×4.0 cm～4.0 cm×6.0 cm;逆行修复手指24例,其中食指12例,中指6例,环指4例,小指2例,皮瓣范围 2.5 cm× 3.5 cm～3.0 cm×7.0 cm.供区均直接闭合. 结果术后皮瓣均成活.经1～3年随访,皮瓣外形及手功能满意,术后3个月开始恢复感觉,1年后恢复保护性感觉.供区外形及功能正常. 结论以掌背皮动脉为蒂的顺行或逆行皮瓣修复腕或手指软组织缺损,是一种较好的手术方法.     

拇指指腹缺损的显微外科修复

目的 探讨含感觉神经的微型皮瓣修复拇指指腹缺损的临床疗效.方法 2000年2月-2010年3月,采用食指背岛状皮瓣、中指侧方岛状皮瓣、以桡侧指动脉为蒂逆行岛状皮瓣、桡动脉掌浅支为蒂的逆行皮瓣、拇指尺背侧动脉逆行皮瓣、拇指背皮神经营养血管皮瓣、第2趾趾腹皮瓣、？？趾甲皮瓣、大鱼际部浅静脉动脉化逆行皮瓣共9种皮瓣修复重建拇指指腹缺损134例.结果 3例皮瓣坏死,131例成活,6个月～1.5年随访108例,皮瓣外形血供充分,质地柔软,感觉测定S2～S4＋,两点辫别觉6～11mm.结论 采用含感觉神经的微型皮瓣修复拇指指腹缺损,对供区影响小、效果佳、为理想的术式选择.     

First dorsal metacarpal artery flap cover for extensive pulp defects in the normal length thumb.

Use of the first dorsal metacarpal artery flap to cover extensive pulp defects in the normal length thumb in five patients is described. The advantages of the procedure include provision of sensate cover of exposed distal phalanx to the tip of the thumb with minimal donor site morbidity. Its use, particularly in the older patient, with immediate postoperative mobilisation and the avoidance of nerve repair or more complicated microsurgical procedures, is discussed.     

第1掌骨背桡侧动脉蒂岛状皮瓣的临床应用

目的探讨第1掌骨背桡侧动脉岛状皮瓣在拇指远端软组织缺损修复中的临床应用。方法应用第1掌骨背桡侧动脉岛状皮瓣修复拇指远端软组织缺损20例。结果本组20例皮瓣全部成活．术后随访3-12个月,拇指外形满意,质地柔软,皮神经修复者两点辨别觉8～12mm。结论第1掌骨背桡侧动脉岛状皮瓣具有操作简便、质地良好、血供可靠、损伤小等优点,是修复拇指远端软组织缺损的较好方法。     

双叶皮瓣瓦合修复拇指脱套伤

目的介绍一种修复拇指脱套伤的新方法。方法采用从深筋膜下取第一掌背神经伴行血管皮瓣，蒂部筋膜宽约2．5～4．0cm，面积（3．0-3．5cm）×（5．0-5.5cm），覆盖拇指尺掌侧。取带拇背侧皮神经营养岛状皮瓣，面积（2．0-3．0cm）×（3．0-6．0cm），覆盖拇指桡背侧，瓦合修复拇指。结果临床应用9例皮瓣完全存活，随防12-36个月，皮瓣质地优良，外观及功能满意，经吻合神经后皮瓣能恢复部分感觉。结论该方法损伤小，操作简单，皮瓣外形好，修复后皮瓣感觉好，两点分辨觉4-6mm，为修复拇指脱套伤提供了一种较为理想的方法。     

逆行第一跖背动脉岛状皮瓣修复(足母)趾腓侧游离皮瓣供区创面

目的应用逆行第1跖背动脉岛状皮瓣修复趾腓侧游离皮瓣的供区,为减少显微外科供区损伤提供新方法。方法2000年2月至2004年6月,对12例拇指及其他手指软组织缺损,采用趾腓侧游离皮瓣移植修复。根据第1跖背动脉和跖底动脉在跖趾关节处存在恒定的交通支的解剖学基础,切取逆行第1跖背动脉岛状皮瓣修复趾供区创面,足背供区直接缝合。结果12例趾腓侧游离皮瓣和逆行第1跖背动脉岛状皮瓣移植全部成活,平均随访10个月,皮瓣外观和功能恢复良好。趾腓侧游离皮瓣平均两点辨别觉为6mm,逆行第1跖背动脉皮瓣为10mm。结论在趾腓侧游离皮瓣移植修复拇指或其他手指软组织损伤的同时,应用逆行第1跖背动脉岛状皮瓣完善修复趾供区创面,达到了＂双赢＂的手术目的。