动脉化静脉皮瓣急诊修复手指软组织缺损

目的总结逆静脉瓣供血、顺静脉瓣回流的动脉化静脉皮瓣急诊修复手指软组织缺损的临床效果。方法2002年10月-2007年3月，采用动脉化静脉皮瓣修复手指皮肤软组织缺损7例，男6例，女1例；年龄17～46岁。受伤原因：挤压伤6例，车床切削伤1例。受伤至手术时间2～7h。缺损范围3．0cm×2．0cm～6．0cm×3．5cm。均采用同侧前臂游离动脉化静脉皮瓣修复创面，皮瓣内静脉近心端分别与手指动、静脉吻合。切取皮瓣范围3．0cm×2．5cm～7．0cm×4．0cm。供区直接拉拢缝合。结果术后6例皮瓣完全成活，1例出现部分表皮坏死，脱痂后愈合。供区创面I期愈合。术后随访3个月～4年，皮肤质地、厚薄均满意，仅1例表皮坏死者出现部分色素沉着。皮瓣均无硬化、挛缩和影响关节活动的现象。按中华医学会手外科学会上肢功能评定标准：优3指，良4指。结论逆静脉瓣供血、顺静脉瓣回流的动脉化静脉皮瓣是目前修复手指软组织缺损的一种较理想方法。

PRIMARY REPAIR OF SOFT TISSUE DEFECT IN FINGERS WITH ARTERIALIZED VENOUS FLAP

OBJECTIVE: To summarize the results of the free transplantation of anti-valve-inflow and pro-valve-outflow arterialized venous flap in repairing soft tissue defect of fingers in emergency treatment. METHODS: From October 2002 to March 2007, 7 cases of soft tissue defects of fingers were repaired with arterialized venous flaps. There were 6 males and 1 female, aged 17-46 years. Defect was caused by crush injury in 6 cases and by stab injury in 1 case. The interval between injury and operation was 2-7 hours and the size of defects ranged from 3.0 cm x 2.0 cm to 6.0 cm x 3.5 cm. All defects were repaired by arterialized free venous flap from the ipsilateral forearm, in which the proximal ends of veins were anastomosed to artery and vein of the finger. The donor site was directly sutured. RESULTS: Six cases of arterialized venous flap survived completely and 1 case had partial superficial necrosis and healed with conservative management. The donor site healed by first intention. Postoperative follow-up ranged from 3 months to 4 years, the texture and the thickness of the flaps were satisfactory, only one presented partial pigment deposits because of superficial necrosis. No sclerosis, contracture and limited range of motion occurred in all flaps. According to the evaluation criteria for upper limb function issued by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 3 cases and good in 4 cases. CONCLUSION: It is an ideal method to repair soft tissue defect of fingers by using anti-valve-inflow and pro-valve-outflow arterialized venous flap.