跨区供血的手部微型岛状皮瓣的设计和应用

目的：探索修复手指中节和末节皮肤缺损的新方法。方法：16例新鲜肢体血管灌注氧化铅－明胶混合液，通过X线片显示手背及指背皮肤内的血管结构和血管之间吻合类型。在此基础上设计并应用了两种不同的跨区供血的手部微型岛状皮瓣，1999年以来共应用14例（以指动脉侧支为蒂的掌背逆行岛状皮瓣8例和以指动脉背侧支为蒂的邻指背侧逆行岛状皮瓣6例）。结果：对指背及掌背皮肤进行解剖，结果表明指动脉背侧皮支与掌背动脉的指背支相互吻合形成皮下血管吻合支，是上述两种皮瓣的解剖基础。临床应用14例，皮瓣全部成活，皮瓣色泽、厚度与质地与手部受区皮肤接近。结论：跨区供血的手部微型岛状皮瓣扩大了指背和掌逆行岛状皮瓣的旋转弧度，为修复手指中节和末节皮肤缺损提供了一种新方法。

A new approach to the reverse dorsal digital and dorsal metacarpal skin flap

Objective To investigate a new method to repair the distal and middle phalanges of the injured finger. Methods Eight fresh cadavers (16 hands) were injected with a lead oxide|gelatin mixture to define the vascular architecture and vascular anastomotic pattern of the dorsum of the proximal phalanx or metacarpal area. To reconstruct the distal or middle phalanges of the injured finger, the reverse dorsal metacarpal flap was used in 8 cases, and the reverse dorsal digital flap was used in 6 cases. A series of 14 cases is reported. Results On the basis of angiographic studies, the two skin flaps were designed on the dorsum of the proximal phalanx or intermetacarpal space based on the vascular anastomosis between the proximal dorsal cutaneous branches of the palmar digital artery and the dorsal digital branches of the dorsal metacarpal artery at the level of the proximal phalanx. All the flaps survived completely. Conclusions The results of our anatomic study and clinical experience confirm the reliability of the dorsal digital and metacarpal island flaps.