手部皮肤软组织缺损皮瓣修复78例效果观察

【目的】探讨应用不同的前臂背侧岛状皮瓣修复手背皮肤软组织缺损的临床效果。【方法】应用骨问背侧动脉岛状皮瓣（35例），骨间前动脉桡侧骨皮支逆行岛状皮瓣（15例），桡神经浅支营养血管为蒂的逆行岛状皮瓣（12例），尺神经腕背支营养血管为蒂的逆行岛状皮瓣（8例），桡动脉鼻烟窝皮支逆行岛状皮瓣（8例）5种不同的前臂背侧岛状皮瓣逆行转移修复78例手背皮肤软组织缺损。【结果】术后71例皮瓣完全成活，i例骨间背侧动脉岛状皮瓣，2例骨间前动脉桡侧骨皮支逆行岛状皮辩，2例桡神经浅支营养血管为蒂的逆行岛状皮瓣，2例尺神经腕背支营养血管为蒂的逆行岛状皮辩远端皮瓣部分坏死，经局部换药2～4周，创面愈合。术后经3个月至2年随访，皮瓣血运、弹性、质地良好。【结论】应用前臂背侧岛状皮瓣逆行转移修复手背部皮肤软组织缺损，手术操作简单、安全，临床效果满意。

Observation on Surgical Flap for Repairing Skin and Soft Tissue Defects of Hand

Objective] To explore the clinical dficacy of island flap from the dorsal forearm for repairing skin and soft tissue defects in the dorsum of hand. Methods] Totally 78 cases of skin and soft tissue defects in the dorsum of hand were repaired by 5 different island flaps from dorsal forearm, which were posterior interosseous artery island flap（PIA）, reversed island flap supplied by radial osteo-cutaneous branch of anterior interosseous artery（AIAR）, reversed island flap supplied by superficial branch of radial nerve and its nourishing blood vessels（RN）, reversed island flap supplied by wrist dorsal branch of ulnar nerve and its nourishing blood vessels（UN） and reversed island flap supplied by cutaneous branch of radial artery in snuff-box region（RA）. Results] After operation, 71 flaps survived completely. The necrosis of distal parts of the flaps was found in 1 case of PIA, 2 cases of AIAR, 2 cases of RN and 2 cases of UN. The necrotic flaps were healed after local dressing for 2 - 4 weeks. During the follow up for 3 months to 2 years, blood supply, elasticity and texture were good. Conclusion]The reversed island flap from dorsal forearm for repairing skin and soft tissue defects in the dorsum of hand is simple and safe, and has satisfactory clinical efficacy.