多种骨间后动脉皮瓣修复上肢软组织缺损

目的 总结多种骨间后动脉皮瓣修复上肢烧(创)伤软组织缺损的临床效果.方法 2003年3月至2010年6月,对42例上肢烧(创)伤软组织缺损的患者,应用包括逆行皮瓣(复合组织瓣)、顺行皮瓣及游离皮瓣在内的多种骨间后动脉皮瓣进行修复,皮瓣面积为2.5 cm×2.0 cm～14.0 cm ×9.0 cm.供瓣区创面直接缝合或移植皮片修复.结果 应用传统型骨间后动脉逆行皮瓣修复11例,改良型骨间后动脉逆行皮瓣修复13例,骨间后动脉逆行肌腱复合瓣修复2例,骨间后动脉顺行皮瓣修复3例,骨间后动脉游离皮瓣修复7例,骨间后动脉桡背侧肌间隔穿支游离皮瓣修复6例.除了应用传统型骨间后动脉逆行皮瓣修复的病例中有1例发生皮瓣远端部分坏死,以及1例发生骨间后神经肌支损伤外,其余皮瓣术后均未发生血管危象,也未出现骨间后神经或其肌支损伤,皮瓣均顺利成活,切口均一期愈合.32例获得1～48个月的随访,皮瓣色泽、质地及厚薄较满意,供、受区外形和功能恢复也较满意.结论 骨间后动脉皮瓣血管解剖恒定,应用形式灵活多样,是修复上肢烧(创)伤软组织缺损的理想选择.

Abstract：

Objective To summarize the therapeutic effect of multiple types of posterior interosseous artery flaps for repair of soft tissue defects in the upper extremities. Methods From March 2003 to June 2010, 42 cases with soft tissue defects in the upper limbs resulting from burn and traumatic injuries were treated using multiple types of posterior interosseous artery flaps, including retrograde flaps and composite flaps, antegrade flaps , and free flaps. Flap size ranged from 2.5 cm× 2.0 cm-14.0 cm×9.0 cm. The defects in the donor sites were closed directly or covered by skin graft. Results The conventional retrograde posterior interosseous artery flaps were used in 11 cases, the modified retrograde posterior interosseous artery flaps were used in 13 cases, the retrograde posterior interosseous artery composite flaps incorporating partial extensors were used in 2 cases, the antegrade posterior interosseous artery flaps were used in 3 cases, the free posterior interosseous artery flaps were used in 7 cases, and the free perforator flap based on the radiodorsal septocutaneous perforator of the posterior interosseous artery were used in 6 cases. Partial necrosis happened in one case at the distal portion of the flap. Muscular branch of the posterior interosseous nerve was injuried in one case with conventional reverse posterior interosseous artery flaps. All the other flaps survived uneventually with no complication. All wounds were primarily healed. 32 cases were followed up for 1 to 48 months with satisfactory aesthetic and functional results both in the donor sites and in the recipent areas. The color,texture and thickness of the flaps were satisfied as well. Conclusions The posterior interosseous artery flap has a constant vascular anatomy and a great flexibility, which is practical and suitable for repair of soft tissue defect in the upper extremities arising from burn and traumatic injury.     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.     

足背动脉逆行岛状筋膜瓣联合植皮在甲皮瓣切取后创面修复中的应用

目的 报告应用足背动脉逆行岛状筋膜瓣联合植皮修复甲皮瓣切取后创面的方法及临床疗效.方法 对8例拇指套脱伤应用甲皮瓣移植修复后,供区创面缺损面积最大为3.5 cm×6.8 cm,最小为2.5 cm×4.9 cm.以足背动脉足底穿支为旋转点,足背动脉体表投影为轴线,在踝前设计足背动脉岛状筋膜瓣,切取足背动脉周缘筋膜组织,结扎足背动脉近端分支,逆行转移至趾切取后的创面,并在筋膜上植全厚皮片、不打包.结果 8例甲皮瓣、筋膜瓣及植皮创面全部存活,对足部血供无影响.术后随访时间为3～18个月,修复后的趾保留正常长度,外形良好,植皮区无挛缩,恢复保护性感觉,趾屈伸活动及下肢行走正常.结论 足背动脉逆行岛状筋膜瓣切取简单,便于旋转,血供丰富,且保留了趾的长度,是修复甲皮瓣切取后遗留创面理想的修复方法.

Abstract：

Objective To report the method and clinical outcomes of covering big toe defects after wrap-around flap transfer with dorsalis pedis artery reversed fascial island flap combined with skin graft. Methods Wrap-around flap transfer was used to reconstruct degloved thumbs in 8 cases,which left soft tissue defects of the big toe ranging from 2.5 cm×4.9 cm to 3.5 cm×6.8 cm. The reverse fascial island flap pedicled by the dorsalis pedis artery was designed at the anterior ankle with the plantar perforator as pivot point and the surface projection of dorsal pedis artery as axis. The fascia around the dorsalis pedis artery was included in the flap. Proximal branches of the dorsalis pedis artery were ligated and the flap was lifted and rotated to cover the big toe defect. Full-thickness skin was grafted on top of the fascial flap. Results All flaps and skin grafts survived. Blood supply of the foot was not compromised. Postoperative follow-up ranged from 3 to 18 months. The length of the donor big toes was preserved. The contour of toes repaired by flaps was good. There was no contracture of skin grafts. Protective sensation was restored. Walking and motion of the toes was normal. Conclusion Dorsalis pedis artery reversed fascial island flap is easy to harvest and rotate. It has rich blood supply. Transfer of this flap can preserve the length and contour of the big toe and therefore is an ideal method to cover donor site defects left by wrap-around flap harvest.     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.     

(足母)趾胫侧趾底动脉逆行岛状皮瓣的临床应用

Objective To study the therapeutic effect of reverse island flap based on tibial plantar digital artery for soft tissue defect at the distal end of first toe. Methods 18 cases with soft tissue defect at the distal end of first toe were treted with reverse island flap based on tibia] plantar digital artery. Results The patients were followed up for 6 ～ 12 months(mean 9.5 months). All the flaps survived completely with good functional and cosmetic results. Conclusions The reversed island flap based on tibia] plantar digital artery has a reliable blood supply and is adjacent to the recipient area. It is practical and suitable for soft tissue defect at the distal end of first toe.     

半趾甲瓣移植手术供区创面的修复处理

目的 探讨半趾甲瓣移植术的供区创面修复方法.方法 自2004年2月至2010年9月,采用带蒂或游离皮瓣修复趾甲瓣足趾供区创面36例40指.趾供区面积较小者13趾采用第一跖背皮瓣、7趾用第二趾动脉皮瓣修复;面积大者采用游离皮瓣修复,其中足底内侧皮瓣3趾,腓动脉穿支皮瓣5趾,跗外侧动脉皮瓣2趾,腓肠动脉内侧支皮瓣3趾.第二趾半趾甲瓣再造手指7趾,其创面均采用(母)趾腓侧岛状皮瓣覆盖.结果 20例术后获得6个月至5年随访,其中2例甲缘外露在皮瓣外,18例(母)趾、第二足趾外观近似正常,皮瓣平整无破溃,皮瓣颜色质地好;游离皮瓣中有7例恢复保护性感觉;修复足趾屈伸活动正常,行走无不适感.结论 用皮瓣移植覆盖(母)趾及第二趾半趾甲瓣创面是理想修复方法,游离皮瓣移植好于带蒂移植.     

半趾甲瓣移植手术供区创面的修复处理

目的 探讨半趾甲瓣移植术的供区创面修复方法.方法 自2004年2月至2010年9月,采用带蒂或游离皮瓣修复趾甲瓣足趾供区创面36例40指.趾供区面积较小者13趾采用第一跖背皮瓣、7趾用第二趾动脉皮瓣修复;面积大者采用游离皮瓣修复,其中足底内侧皮瓣3趾,腓动脉穿支皮瓣5趾,跗外侧动脉皮瓣2趾,腓肠动脉内侧支皮瓣3趾.第二趾半趾甲瓣再造手指7趾,其创面均采用(母)趾腓侧岛状皮瓣覆盖.结果 20例术后获得6个月至5年随访,其中2例甲缘外露在皮瓣外,18例(母)趾、第二足趾外观近似正常,皮瓣平整无破溃,皮瓣颜色质地好;游离皮瓣中有7例恢复保护性感觉;修复足趾屈伸活动正常,行走无不适感.结论 用皮瓣移植覆盖(母)趾及第二趾半趾甲瓣创面是理想修复方法,游离皮瓣移植好于带蒂移植.     

足部一蒂多瓣同时修复手部多处皮肤缺损

目的 介绍足部一蒂多瓣同时修复手部多处皮肤缺损的临床效果.方法 对8例19处手部创面采用一蒂多瓣的方法进行修复,其中以第一跖底动脉为蒂的第一、二趾侧方皮瓣修复5例12处;以足背动脉为蒂的跗外侧皮瓣及第一、二趾侧方皮瓣修复1例3处;以足背动脉为蒂的足背皮瓣及(足母)趾趾腹皮瓣修复2例4处.结果 术后8例19块皮瓣全部存活,随访时间为3～ 36个月,皮瓣外形逼真,两点分辨觉为5～11 mm,有排汗功能,术后供区植皮创面Ⅰ期愈合.结论 足部一蒂多瓣是同时修复手部多个创面的理想方法,它简化了手术步骤,缩短了手术时间,但应根据损伤类型、面积选择最合适的皮瓣.     

显微外科皮瓣修复[足母]甲瓣供区的临床应用

目的探讨应用显微外科皮瓣对[足母]甲瓣供区进行修复的临床疗效,并对皮瓣选择做出分析。方法应用5种近位足部带蒂皮瓣和2种远位游离皮瓣对57例[足母]甲瓣供区软组织缺损进行修复。其中近位带蒂皮瓣33例:带蒂足跗外侧动脉皮瓣2例,以第1跖背动脉的跖蹼穿支为蒂的足背逆行皮瓣15例,带第1跖背动脉的足背逆行皮瓣3例,顺行足第2趾胫侧皮瓣11例,逆行足底内侧皮瓣2例,足部皮瓣供区行全厚皮片游离植皮。远位游离皮瓣24例:游离腹股沟皮瓣13例,游离股前外侧皮瓣11例。皮瓣供区均直接缝合。结果57例皮瓣中53例成活良好;以第1跖背动脉的跖蹼穿支为蒂的足背逆行皮瓣3例远端部分坏死,经换药治疗后创面愈合;游离腹股沟皮瓣1例术后发生血管危象,经血管探查术后未缓解,Ⅱ期行游离植皮修复[足母]甲瓣供区创面。术后随访2~12个月,行走姿态良好。结论合适的显微皮瓣技术可以良好的修复[足母]甲瓣供区创面,保全肢体的完整性,减少医源性损伤,患者更容易接受[足母]甲瓣移植的手术方式。皮瓣选择不应只关注[足母]趾供区的修复,更应合理运用显微皮瓣技术,重视供、受区的平衡。     

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。     

踇甲瓣切取术后创面的处理

目的 探讨踇甲瓣切取术后创面的覆盖办法.方法 对34例病例其中踇甲瓣再造拇指8例;踇趾腓侧半趾甲瓣移植22例(再造拇指8例、示指10例、中指2例);踇趾背侧甲瓣移植4例,对供区创面采用了带蒂皮瓣(第一跖背皮瓣、第二足趾趾动脉岛状瓣、第二足趾趾背邻趾皮瓣、跗外侧皮瓣):游离皮瓣(跖底内侧皮瓣、腓动脉皮瓣、跗外侧皮瓣)等覆盖. 结果 术后2个月内随访12例,步态正常;4个月随访6例(4例为第一跖背皮瓣、1例腓动脉皮瓣、1例跖底内侧皮瓣).2例皮瓣有保护性的感觉,颜色略黑;跖底内侧皮瓣和第二趾动脉皮瓣,感觉正常.对供区创面用皮瓣修复其外形丰满有弹性,踇趾腓侧半趾甲瓣用皮瓣修复的踇趾外形酷似原踇趾.趾甲皮瓣移植修复外形佳,形成瘢痕少;步态正常;供趾无不适感. 结论 踇趾切取甲瓣、踇趾腓侧半侧甲瓣、踇趾背侧甲瓣后遗留创面采用皮瓣修复既可避免疼痛、破溃等并发症.又使供足有满意的外形,因此是一种理想的修复方法.     

四肢组织瓣移植供区继发损伤的处理方法探讨

目的探讨四肢组织瓣移植后供区创面处理的方法,为减少供区并发症提供新思路。方法在进行组织瓣移植的36例中,采用不同的处理方法来减轻或修复供区继发损伤。其中3例(足母)趾甲皮瓣和2例足背皮瓣创面采用次要部位的游离皮瓣修复;5例股前外侧皮瓣供区创面采用同侧腹股沟皮瓣逆转修复;3例(足母)趾腓侧皮瓣供区采用第一跖背动脉皮瓣逆转修复;3例足背皮瓣复合第二趾移植供区采用外踝上皮瓣逆转修复;7例肌瓣和筋膜瓣移至受区后表面植皮,供区直接缝合;13例皮神经营养血管皮瓣分离血管蒂时,保留皮神经在原位。结果所有治疗原发和继发损伤的移植皮瓣均成活,应用带蒂或游离肌瓣、筋膜瓣加表面植皮者,3例植皮完全成活,4例植皮大部成活,皮神经营养血管皮瓣供区及其以远感觉接近正常。结论四肢组织瓣移植后供区继发损伤的处理值得重视,在治疗原发损伤的同时,采用各种方法修复或减少供区损伤,是降低供区并发症的重要措施。     

不同足趾甲皮瓣游离移植修复手指甲床缺损的临床研究

目的探讨应用不同足趾甲皮瓣游离移植修复手指甲床缺损的临床疗效。方法2006年1月-2011年1月,在相关解剖学研究的基础上,采用不同足趾甲皮瓣游离移植修复手指甲床缺损32例35指．包括坶趾甲皮瓣20指,第2趾甲皮瓣12指,第3趾甲皮瓣3指。结果术后足趾甲皮瓣全部成活．2例指甲皮瓣略显臃肿,予二期手术修整。术后随访评定3～6个月,患指功能恢复满意。指甲生长良好,供区功能无明显影响。参照Zook指甲修复评定标准评定：优30指,良3指。中2指。优良率达94．3％。结论不同足趾甲皮瓣游离移植术,操作简便,成功率高,是修复手指甲床缺损较理想的手术方法。     

应用皮瓣修复游离足趾移植后供区创面

目的评价应用皮瓣修复游离足趾移植再造拇、手指术后供区创面的临床效果。方法选择同侧跖背动脉岛状瓣修复1例、趾腓侧岛状瓣修复2例、外踝皮瓣修复1例、胫后动脉穿支皮瓣修复3例、腓动脉穿支皮瓣修复1例,共8例足部供区创面;趾指骨对换修复1例第二趾近趾间关节移植术后足部继发趾骨缺损。结果8例足部供区创面各皮瓣血运良好,创面均一期愈合。1例指骨对换患者术后2个月骨全部愈合。经3—6个月随访,供足恢复正常的行走功能,外形美观,无行走疼痛症状发生,皮瓣感觉功能部分恢复。结论足趾移植后应用皮瓣修复供区,最大限度地保留了足部的正常结构,恢复足部外形和功能。     

急诊一期组合组织移植再造手

目的:采用吻合血管组合组织移植一期修复手部大范围多元组织缺损再造手。方法:①指缺失:用第2足趾或躅甲瓣再造拇指,用第2、3足趾再造其它手指。②软组织缺损:虎口及手掌皮肤缺损用股前外侧皮瓣修复并同时用股前外侧皮神经重建受区感觉功能,大范围皮肤缺损则用股前外侧皮瓣组合其它皮瓣修复。③掌指关节及掌骨缺损:掌指关节缺失用跖趾关节重建,掌骨缺失用跖骨或髂骨重建。结果:33例75个游离组织全部成活,再造手功能恢复良好,皮肤感觉恢复。结论:吻合血管组合组织移植一期再造手,具有最大限度的保留手部残存非失活组织及功能,最大限度修复重建手部功能的优点,是理想的治疗方法。