应用踝前与足背联合皮瓣游离移植修复手掌部贯通伤皮肤缺损

目的 探讨应用踝前与足背联合皮瓣游离移植修复手掌部贯通伤皮肤缺损的临床效果.方法 从2004年5月至2009年7月,应用踝前与足背联合皮瓣游离移植修复手掌部贯通伤皮肤缺损16例,两皮瓣由足背动、静脉相连,踝前皮瓣切取范围:3.5 cm×2.0 cm～7.0 cm×5.5 cm;足背皮瓣切取范围:5.0 cm×3.5 cm～8.5 cm×6.0 cm.结果 16例32块皮瓣全部成活,术后随访6个月～2年,根据2000年中华医学会手外科分会手功能评定试用标准综合评价:优8例,良5例,可2例,差1例,优良率为81.25%.结论 踝前与足背皮瓣血管解剖恒定,手术切取比较简便,一次手术可以完成手掌和手背两侧皮肤缺损的修复,应用踝前与足背联合皮瓣游离移植修复手部贯通伤可以获得较好的临床效果.

Repairment of skin defects secondary to penetrating wound of palm with the application of free string-type dorsalis pedis flap and anterior malleolus flap

Objective To investigate the clinical outcome of the feasible method of the free string type dorsalis pedis flap and anterior malleolus flap in the repairement of skin defects caused by penetrating wound of palm. Methods From May 2004 to July 2009, the free string-type dorsalis pedis flap and anterior malleolus flap were used to repair skin defects of 16 cases who sutained penetrating wounds of palm.Results All 32 flaps in the 16 cases were all survived. Follow-ups were done from 6 months to 2 years after operation. Both the appearances of the repaired palms and the functional recovery were satisfactory. The function assessment of the hand was excellent in 8 cases, good in 5 cases, fine in 2 cases and poor in 1 case.The eligible rate was 81.25%. Conclusion The anatomy of the dorsalis pedis flap and anterior malleolus flap is rare variant, which facilitate the dissection of the flaps during operation. The repairement of skin defects at two sides, both the palm and the back of hand, can be achieved via one operation. Therefore, the free string type dorsalis pedis flap and anterior malleolus flaps offer an ideal procedure to repair skin defects secondary to penetrating wound of palm.