指背逆行皮瓣修复手指远端软组织缺损的应用研究

目的研究手指远端软组织缺损使用指背逆行皮瓣修复的应用价值。方法尸体手4只，死婴手6只，经乳胶血管灌注，观察手指的动脉、静脉分布。在尸体手指背侧设计10个逆行皮瓣，蒂部在手指远端的一侧，皮瓣范围3cm×1．5cm，将泛影葡胺加墨汁加压注入桡动脉，肉眼观察皮瓣的颜色变化，X线造像观察皮瓣内血管显影情况。在手指解剖学研究的基础上，对22例手指烧伤、外伤患者，应用了27个指背逆行皮瓣修复手指远端皮肤缺损伴有肌腱、指骨、指关节外露创面，皮瓣范围（1—5．5）cm×（1—3）cm，长宽比例（1—2．5）：1。结果解剖学研究见手指动脉间有多方位、层次交错的吻合，静脉间相互吻合成网，保证了手指的血液供应和静脉回流。指背逆行皮瓣的蒂部可见有指掌侧固有动脉的分支，灌注后可见皮瓣内静脉即刻充盈黑染，说明实验皮瓣已完成“血液”从动脉-毛细血管-静脉的循环过程，皮瓣X线造像显示整体透光度减低，皮瓣内有血管显影。本组临床移植的27个皮瓣全部成活，随诊6—12个月，远期效果满意。结论指背逆行皮瓣的血液供应来源于指掌侧固有动脉的分支，皮瓣内有丰富的静脉并与指腹僻静脉形成网状交通，保证了皮瓣的血液回流。指背逆行皮瓣可以较好地满足手指远端皮肤软组织缺损修复的需要，特别是对手指远端、小指末节尺侧、拇指末节桡侧等使用局部皮瓣修复困难的部位。

Application of flyback finger flaps on the repair of distal finger end soft tissue defect

Objective To study the applicative value of flyback finger flaps on the repair of distal finger end soft tissue defect. Methods The distribution of arteries and veins in fingers of 4 hands from corpuses and 6 hands from dead infants were observed after emulsoid infusion in blood vessels. Ten flyback flaps sized 3 cm × 1.5 cm each was designed at the corpus＇ finger back with the pedicles at the distal end of fingers. The color changes of the flaps were macroscopically observed after the mixture of diatrizoate and Indian ink were infused into radical artery with pressure and the visualization of the blood vessels inside the flaps were observed radiologically. Based on the knowledge from finger anatomy,27 flyback finger flaps were used to repair the distal finger end skin defect with opened tendons, finger bones and joints. The flaps used were sized （ 1 - 5.5 ） cm×（ 1 - 3） cm with the ratio of length to width （ 1 - 2. 5 ） ： 1. Results Crossed dimensional arterial and venous anastomosis has been observed in finger anatomical studies which ensure the blood supply and venous return. Some innate digital palmar branches could be seen at the pedicle of flyback finger flaps in which veins can be stained to black soon after infusion. It indicated that the blood circulation of arteries to capillaries to veins have completed. The radiogram of flaps showed that the overall transmittancy has been decreased and some blood vessels were visible radiologically. All of the 27 flaps transplanted in this study alive clinically and the follow-up showed a satisfactory long term results in 6 to 12 months. Conclusions The blood supply to flyback finger flaps was derived from the innate branches of digital palmar arteries. The plentiful veins inside the flaps form a net with the digital palmar veins to guarantee recirculation in flaps. The flyback finger flaps can meet the needs well for repairs of skin and soft tissue defect at the distal finger end, especially at some repair difficult parts such as ulnar paratelum of di