手部软组织缺损两种皮瓣修复方法的比较

目的探讨并比较跗外侧动脉皮瓣与腓动脉穿支皮瓣修复手部软组织缺损的方法及临床效果，为两者的临床选择提供依据。方法2010年10月～2013年10月，选取23例手部软组织缺损的患者，采用跗外侧动脉皮瓣修复手指部软组织缺损10例；采用腓动脉穿支皮瓣修复手指部软组织缺损10例、手背部软组织缺损3例。结果本组23例皮瓣全部成活，术后随访3个月-1年，跗外侧动脉皮瓣与手部肤色、纹理接近，质地柔软、弹性良好、耐磨，外观较佳，对手指屈伸功能无影响，皮瓣两点辨别觉达5～8mm；术后3例供区植皮部分坏死，换药治疗7—21d后，2例愈合，1例行二次游离植皮，足部活动良好。腓动脉穿支皮瓣质地柔软、弹性好、耐磨、皮瓣两点辨别觉达8—10mm，但较周围肤色稍深、纹理较疏松：术后4例因皮瓣臃肿行削薄手术；小腿供区9例仅留线状瘢痕，4例植皮成活良好对供区外观影响小，功能无影响。结论手部较小面积的软组织缺损采用跗外侧皮瓣修复外观及功能较佳，但足部供区植皮容易坏死应注意防范；腓动脉穿支皮瓣对供区损伤小，适宜修复手部中等面积的软组织缺损；根据手部软组织缺损部位及程度，选择适宜皮瓣修复，可以达到更为满意的临床效果。

COMPARISON OF TWO KINDS OF FLAP REPAIR TREATING HAND SOFT TISSUE DEFECT

Objective To explore the methods to repair hand soft tissue defect with the lateral tarsal artery flap and with perforator artery flap and compare the clinical effects, provide the basis for the clinical choice. Methods From October 2010 to October 2013, select 23 cases of hand soft tissue defect patients, 10 cases of defect in fin- gers were repaired by lateral tarsal artery flap; 10 cases of defect in fingers and 3 cases of defect in the back of the hand were repaired by perforator artery flap. Results The flaps all survived, followed - up range from 3 months ~ 1 year, the appearance and function were satisfactory. Lateral tarsal artery skin flap were well, which no obviously bloated. Two - point discrimination was 5 - 8 ram. 3 cases of postoperative treatment 7 d to 21 d after treatment, 2 ca- ses of healing, 1 second free skin graft, good foot activities. Perforators artery flap texture soft, good elasticity, wear -resisting, flap two -point discrimination was 8 ~ 10 mm, but the skin around a bit color deep, texture is relatively loose; 4 cases of postoperative surgery for cutting thin flap bloated ; Calf for 9 cases only with linear scar, 4 cases of skin graft survival of donor area good appearance effect is small, after functional rehabilitation the hand function were satisfactory. Conclusion Hand smaller area defect repaired by the lateral tarsal artery flap is better in the appearance and function, the medium area suitable for repaired by perforators artery flap. According to the characteristics of de- fect shape and area selecting free flap for soft tissue defects of hand and wrist, can achieve fine repair effect and great- ly improve hand function.