手背皮神经营养血管皮瓣修复手外伤的临床应用

目的探讨手背皮神经营养血管皮瓣修复手外伤后软组织缺损的临床应用效果。方法回顾性分析应用掌背皮神经营养血管筋膜蒂皮瓣、桡神经浅支腕背皮神经营养血管筋膜蒂皮瓣、指固有神经背侧支筋膜岛状皮瓣、尺神经手背支营养血管筋膜岛状皮瓣修复196例手部软织缺损。结果移植皮瓣全部成活，术后出现3例轻度感染，5例皮瓣部分坏死，经换药后愈合良好。随访190例，优105例，良81例，可4例。结论手部外伤后软组织缺损，根据软组织的不同缺损情况，选用恰当的皮瓣修复方法．具有创面直接覆盖、感染率低、保留手指长度、手部外形良好等优点。

Use of cutaneous neurovascular flaps harvested from the dorsa of the hands for the soft tissue defects in the hands

Objective To study the use of cutaneous neurovascular flaps harvested from the dorsa of the hands for coverage of the soft tissue defects in the hands. Methods In this series, 196 soft tissue defects of the hands were reconstructed by using ipsolateral dorsal metacarpal neurovascular fasciocutaneous flap, dorsal carpal cutaneous branch neurovascular fascia flap, dorsal digit neurovascular fascia flap, and dorsal ulnar superficial neurovascular fascia flap. Results All flaps survived. Mild infection and partial necrosis of the flaps were noted in 3 and 5 cases, respectively. The complications were relieved after changing dressing. At the final follow-up, 190 of 196 cases were assessed. There were excellent, good, and fair results in 105, 81, and 4 cases, respectively. Conclusion The cutaneous neurovascular flaps harvested from the dorsa of the hands can be used for reconstruction of soft tissue defects in the hands, with low risk of infection and maintenance of a normal digit length. Selection of use of the flaps is mainly based on the location, shape, and size of the soft tissue defect.