游离足背皮瓣修复手背皮肤软组织缺损

目的 探讨游离足背皮瓣修复手背皮肤软组织缺损的临床效果.方法 对10例手背软组织缺损的患者,切取带腓浅神经的游离足背皮瓣移植修复,其中1例携带第3、4趾趾长伸肌腱,1例同时切取第二足趾再造中指.皮瓣切取面积为5 cm×4 cm～21 cm x 12 cm.结果 10例皮瓣全部存活,术后1例皮瓣发生血管危象,经手术探查发现静脉血栓形成,重新吻合血管后皮瓣存活.术后随访6～24个月,其中9例皮瓣无臃肿,皮肤质地、色泽接近正常皮肤,痛、温、触觉部分恢复;1例皮瓣肤色较深,质地硬.3例供区植皮坏死、肌腱外露,其中1例经换药后瘢痕愈合,1例行小腿内侧筋膜皮瓣修复,1例行足内侧岛状皮瓣修复.结论 应用足背皮瓣复合组织修复手背皮肤、肌腱和神经的缺损,是一种较理想的方法.

Repair of soft tissue defect on dorsum of the hand with free dorsalis pedis flap

Objective To evaluate the clinical outcomes of repairing soft tissue defect on dorsum of the hand by free dorsalis pedis flap transfer. Methods Ten cases of soft tissue defects on dorsum of the hand were treated. Dorsalis pedis flap including the superficial peroneal nerve was harvested and transferred to cover the defects. In one of the 10 cases, the 3rd and 4th toe extensor tendons were also included in the flap. In the other case, the second toe was transferred simultaneously to reconstruct the middle finger. The sizes of the harvested flaps ranged from 5 cm x 4 cm to 21 cm 12 cm. Results All 10 flaps survived. Postoperative vascular crisis occurred in 1 ease. Surgical exploration revealed venous thrombosis. The flap survived after resection of the thrombotic site and vascular re-anastomosis. Postoperative follow up period was 6 to 24 months. In 9 eases the flaps were not bulky. The texture and color of the skin were near normal. Partial recovery of pain, temperature and touch sensation was observed. In 1 ease the skin was dark and hard. Necrosis of skin grafts at the donor site with exposed tendons was seen in 3 cases. One case healed secondarily after dressing change; one was treated by transferring medial fascial flap from the lower leg; one case was repaired with medial tarsal island flap. Conclusion Composite dorsalis pedis flap is an ideal mehed to repair defects of skin, tendon and nerve on dorsum of the hand.