应用数字减影血管造影术指导皮瓣选择修复严重手外伤创面

目的本文探讨数字减影血管造影术(Digital subtraction angiography,DSA)在严重手外伤治疗中,对皮瓣选择的指导作用。方法回顾性分析我科治疗的6例手外伤患者,创面均有肌腱和(或)骨外露,所有患者均行DSA检查,明确前臂和手的血供情况,包括桡动脉、尺动脉的走行及其穿支动脉、掌深弓掌浅弓的存在与否等。根据造影结果,综合评价血管损伤情况和邻近的软组织条件,并据此选择逆行前臂岛状皮瓣或远位游离皮瓣修复创面。结果 4例患者前臂及手掌部主干血管无损伤,选择逆行前臂轴型皮瓣修复。2例患者因前臂桡动脉断裂、掌深弓掌浅弓完整性缺失而选择游离轴型皮瓣修复创面,术后皮瓣均存活。结论 DSA造影可以清晰显示患侧前臂和手的血管网,发现可能存在的血管损伤,能有效地指导皮瓣的选择,提高皮瓣选择的合理性和皮瓣移植的成功率。

Application of Digital Subtraction Angiography for Selecting Skin Flap in Hand Trauma

Objective To explore the guiding effect of digital subtraction angiography （DSA） in selecting skin flaps for covering hand defects. Methods Retrospective analysis was made on six patients who had severe hand injury with the exposure of tendon and （or） bone. All the patients accepted DSA examination to determine the blood supply of forearm and hand, including radial artery, ulnar artery, perforating arteries, deep palmar arch and superficial palmar arch. According to the results of angiography, the vascular injury and the adjacent soft tissue conditions were evaluated. Then the reverse forearm island flap or distal free flap was selected to repair the wound. Results Four patients＇ radial artery, ulnar artery and palmar arehs were intact so that reverse forearm island flap was selected. The other two patients~ radial arteries were broken so that the free axial flap was selected. The flaps all survived completely. Conclusion DSA can clearly display the vasoganglion of the injured forearm and hand, detect the possible vascular injury, and effectively guide the selection of skin flap. The use of DSA improves the rationality of flap selection and the success rate of flap transplantation.