应用局部岛状皮瓣修复手和腕部小范围深度缺损

目的：探讨手和腕部小范围深度缺损局部岛状皮瓣的修复方法，总结最大程度减轻手畸形和功能障碍的技巧。方法：将手和腕的缺损分为手指缺损，虎口和指蹼缺损，手背、手掌和腕部缺损，清创后分别用掌背动脉岛状皮瓣、指掌侧固有动脉岛状皮瓣、尺动脉腕上皮支岛状皮瓣和骨间背侧动脉岛状皮瓣转移修复，供瓣区游离植皮或直接拉拢缝合。结果：37例患者42个手和腕部创面，皮瓣转移后38个皮瓣全部成活，创面愈合良好，近远期效果好，功能恢复满意。1个皮瓣因血运障碍全部坏死，二次手术转移腹部皮瓣治愈，其他3个皮瓣也因血运障碍致使皮瓣远端0．2—0．6cm范围坏死，通过换药愈合。结论：上述皮瓣位于创面临近部位，切取容易，操作简便，修复创面可使创面Ⅰ期愈合，避免感染、后期畸形和功能障碍等并发症的发生，远期效果好，不失为一种修复手和腕部小范围深度缺损首选的方法。

Repair of tiny range deep defects of hands and wrists with local island skin flaps

Objective:To explore the application of local island skin flap to repair tiny range deep defects on hands and wrists,and summarize the skill that relieves hands deformation and functional impairment.Methods: The defects on hands and wrists were comprised of finger defect,thumb web-space and digital web-space defect,palm,dorsum manus and wrist defect.Those defects were repaired with dorsal metacarpal artery island flap,proper palmar digital artery island flap,epithelial branch of ulnar artery island flap and arteriae interossea posterior island flap after debriding.The donor site was covered with skin graft or sutured directly.Results: Of 42 wounds in 37 patients,38 flaps survived after flap transferring,and the wounds were healed well.The recent and long-term effect,functional recovery were satisfied.One case with total necrosis resulted from poor blood supply was healed with transferring abdominal flap,and 3 cases of local necrosis(0.2 to 0.6 cm) at the distal end of flap were healed by dressing change.Conclusion: The flaps nearing to wounds can be cut readily and operated conveniently.Wound repair with these flaps could make wound primary heal and avoid complications such as infection,later deformation,functional impairment and so on.The application of local island skin flap is a first choice to repair tiny range deep defects on hands and wrists.