第1掌骨桡背侧动脉游离皮瓣修复手指软组织缺损的临床应用

目的　探讨第1掌骨桡背侧动脉游离皮瓣修复手指软组织缺损的手术方法和临床效果。 方法　2014年12月~2016年7月，采用第1掌骨桡背侧动脉皮瓣游离移植修复手指皮肤软组织缺损6例。于第一掌骨桡侧背设计皮瓣，以鼻烟窝至第1掌指关节桡背侧的连线为轴线，切取的皮瓣内含第1掌骨桡背侧动脉及桡神经浅支拇指桡背侧支，与创面指动脉神经吻合，重建皮瓣血供及感觉。切取面积2.5~4.0 cm×1.5~2.5 cm。 结果　6例全部成活，随访2~8个月，皮瓣质地柔软，耐磨，外观理想，皮瓣感觉恢复至S3~S3+级，两点辩别觉5.0~8.0 mm。供区创面直接缝合呈线形瘢痕，拇指活动正常，供区以远部分皮肤感觉减退。患指指间关节活动无明显受限。 结论　该皮瓣具有轴心血管较固定，供区损伤小，切取方便，质地良好，血供可靠等优点，重建手指感觉恢复满意，为修复手指皮肤软组织缺损较理想方法之一。

The anatomy and clinical application of the first metacarpal radial dorsal artery free flap in repairing finger soft tissue defect

Objective　To report the anatomy and surgical methods and clinical effects of using the first metacarpal radial dorsal artery free flap for reconstruction of a finger soft tissue defect.　Methods　From December 2014 to July 2016, 6 fingers soft tissue defect were treated by microscopic reparation with the first metacarpal radial dorsal artery flap. The flap was designed in the radial aspect of the first metacarpal bone, the connection from the snuff box to the radiodorsal aspect of the first metacarpophalangeal joint serves as the axis, and the first metacarpal radiaodorsal artery and radiodorsal branch to the thumb from the superficial branch of the radial nerve were anastomosed, respectively, to the artery and nerve at the would. The flap sizewas about 2.5~4.0 cm×1.5~2.5 cm.　Result　6 cases all survived, and followed up for 2 to 8 months. The texture of flaps were soft and wear-resisting, and the appearance of that was satisfactory. The sensation of flaps was restored to S3~S3+ level and two-point discrimination was about 5.0~8.0 mm. The wounded area was sutured directly and healed in a linear scar. The activity of thumbs was normal and feeling of distal skin of flaps was diminished. Activity of all interphalangeal joints was not significantly limited and excellent in 4 cases, good in 2 cases according tothe TAM assessment criteria, and the excellent and good rate was 100%. Conclusion　The flap has consistent axial vessels, smaller damage area, easier harvest, better texture, more reliable blood supply and other advantages. It can help to reconstruct more satisfying feeling of wounded finger and provide a new and effective method to repair finger skin defect.