游离尺动脉腕上皮支下行支皮瓣修复手指创面的应用研究

目的 研究游离尺动脉腕上皮支下行支皮瓣修复手指创面的手术方法 ,观察其临床应用效果.方法 2001年3月至2006年12月,对75例(79指)手指软组织缺损患者,采用以尺动脉腕上皮支下行支为血管蒂的游离皮瓣进行修复,其中59例(62指)采用急诊或延迟手术修复,16例(17指)采用择期手术修复.临床应用过程中观察血管是否存在变异情况.结果 术后75例(79指)皮瓣全部成活,1例皮瓣远端部分坏死,经植皮后愈合.术中发现尺动脉腕上皮支存在三种不同类型的变异,包括皮支发出位置、皮支数目、非尺动脉发出皮支三种,经过相应的手术措施,血管变异的皮瓣全部成活.所有皮瓣术后随访6～24个月,平均14个月,皮瓣质地、外形满意.重建感觉者,两点分辨觉为6～11 mm;未行感觉神经修复者,半年后皮瓣均恢复保护性感觉.手指功能恢复满意.结论 应用尺动脉腕上皮支下行支皮瓣修复手指创面,血管解剖较恒定,操作简便,术后皮瓣外形、皮肤质地及功能均较满意,可以重建感觉功能,值得临床推广应用.

Repairing finger defects with free vascularized flaps based on the descending branch of the upper-wrist cutaneous branch of ulnar anery

Objective To study a new surgical method to repair finger defects with free vascularized flaps based on the descending branch of the upper-wrist cutaneous branch of ulnar artery, and evaluate the clinical effects.Methods From March 2001 to December 2006, 75 patients (79 fingers) suffered soft were treated using free flaps pedicled with the descending branch of the upper-wrist cutaneous branch of ulnar artery.There were 41 males (45 fingers) and 34 females (34 fingers), with the mean age of 31 years (ranged from 20 to 45 years).Among them, 59 cases of 62 fingers adopted emergency surgery or delay surgery to repair, 16 cases of the 17 fingers adopted selective operation to repair.Vascular variations were studied in the process.Results The grafted flaps in all 79 fingers of 75 patients successfully survived except for one necrosis case in the distal part of the flap, which was then healed with skin grafting.Three different types of variation of the upper-wrist cutaneous branch of ulnar artery were identified in the operation, including the origin and the number of cutaneous branches, and corresponding surgical approaches had contributed to successful survival of the flaps pedicled with vascular variations.Follow-up studies that lasted 6-24 months after the procedure revealed adequate texture and shape of the flaps with the two-point discrimination of 6-11 mm, did not match nerves, skin protection 6 months after the restoration of feeling, the functional recovery of the fingers being satisfying.Conclusion It can provide the relatively constant vascular anatomy and easy operation to repair finger defects with free vascularized flaps based on the descending branch of the upper-wrist cutaneous branch of ulnar artery, and get satisfied skin flap appearance, texture and feeling function.