双轴点掌背皮动脉皮瓣修复腕手指软组织缺损

目的探讨应用双轴点掌背皮动脉皮瓣修复腕或手指软组织缺损的手术方法及其疗效. 方法 1995年～2003年,通过解剖学研究发现,由掌背动脉发出的近侧及远侧皮支在皮下组织内形成恒定的弓状动脉吻合,以其近侧或远侧皮支为蒂,手背皮肤为供区,可形成顺行或逆行岛状皮瓣.临床应用了27例,采用顺行修复手背3例,皮瓣范围2.0 cm×4.0 cm～4.0 cm×6.0 cm;逆行修复手指24例,其中食指12例,中指6例,环指4例,小指2例,皮瓣范围 2.5 cm× 3.5 cm～3.0 cm×7.0 cm.供区均直接闭合. 结果术后皮瓣均成活.经1～3年随访,皮瓣外形及手功能满意,术后3个月开始恢复感觉,1年后恢复保护性感觉.供区外形及功能正常. 结论以掌背皮动脉为蒂的顺行或逆行皮瓣修复腕或手指软组织缺损,是一种较好的手术方法.

REPAIR OF SOFT TISSUE DEFECTS OF WRIST AND FINGERS BY ANTEGRADE AND RETROGRADE DORSAL METACARPAL FLAPS WITH CUTANEOUS BRANCHES AS PEDICLES

OBJECTIVE: To investigate the procedure and applications of antegrade and retrograde dorsal metacarpal flaps with cutaneous branches as pedicles in repairing soft tissue defects of wrist and fingers. METHODS: From 1995 to 2003, we observed that the proximal and distal branches, deriving from the dorsal metacarpal artery, formed a consistent anastomosis arc subdermally. The anastomosis arc was paralleled to the dorsal metacarpal artery. Antegrade and retrograde dorsal metacarpal flaps could be designed using proximal and distal branches as pedicles. Twenty-seven cases of soft tissue defects were treated by use of dorsal metacarpal flaps with cutaneous branches as pedicles, including 3 cases of defects on dorsum of hand with antegrade flaps, and 24 cases of defects on fingers with retrograde flaps (index finger: 12 cases; middle finger: 6 cases; ring finger: 4 cases; and little finger: 2 cases). The dimensions of the antegrade flaps were 2.0 cm x 4.0 cm - 4.0 cm x 6.0 cm, and the dimensions of the retrograde flaps were 2.5 cm x 3.5 cm - 3.0 cm x 7.0 cm. The incision of the donor site was closed directly. RESULTS: All flaps survived. After a follow-up of 1-3 years, the texture and color of the flaps were good, and the shape and function of the donors were normal. CONCLUSION: The antegrade or retrograde flap pedicled with the distal or proximal cutaneous branches of the dorsal metacarpal artery, is an optimal flap in repairing finger or wrist soft tissue defects.