游离尺动脉腕上皮支皮瓣在皮肤缺损性断指中的应用

目的：探讨游离尺动脉腕上皮支皮瓣在皮肤软组织缺损性断指再植中的方法和临床效果。方法 ：自2007年4月至2013年3月,采用尺动脉腕上皮支皮瓣游离移植修复皮肤缺损性创面,并再植25例（均为经非重要位置短缩再植后仍有皮肤软组织缺损的患指）,其中男18例,女7例;年龄16-58岁,平均31.5岁。受伤至入院时间45-210 min,平均105 min。完全离断15例,不完全离断10例。皮瓣切取范围3.5 cm×2.0 cm-4.5cm×3.0 cm。血管采用端-端方法吻合。术后按中华医学会手外科学会断指再植功能评定标准进行功能评价。结果：术后24例成活,2例48 h内出现血管危象,其中1例予以抗痉挛并换药后缓解,最后皮瓣边缘少许坏死,经换药后愈合,1例再植手指坏死,予以残端修整。1例出现断指创口感染,经换药愈合。24例获随访,时间3-38个月,平均16.5个月。皮瓣外观、质地良好,皮瓣及手指浅痛觉及触觉恢复,两点辨别觉为5.5-11 mm,平均7.4 mm。根据中华医学会手外科学会断指再植功能评定标准：优8例,良14例,差2例。结论：在单个合并皮肤软组织、血管缺损的复杂性断指再植中,应用游离尺动脉腕上皮支皮瓣,可同时修复血管缺损及创面,可以避免过多的短缩患指,扩大了断指再植适应证,可以最大程度的恢复患指的功能和外形。

Application of free flap pedicled with supracarpal cutaneous branch of ulnar artery in repairing of finger replantation with skin defect

Objective: To evaluate clinical application and clinical outcomes of free flap pedicled with supracarpal cutaneous branch of ulnar artery in repairing of finger replantation with skin defect. Methods: From April 2007 to March 2013,25 patients affected by finger amputation with skin defect were replanted and repaired by free flap pedicled with supracarpal cutaneous branch of ulnar artery. Among them,18 patients were male and 7 were female,with an average age of 31.5 years old(ranged 16 to 58). The time of trauma to admission ranged from 45 to 210 min (averaged 105). Fifteen patients were complete separted,and 10 patients were non-complete separated. The area of flaps ranged from 3.5cm×2.0 cm to 4.5 cm×3.0 cm,and the vessels were anastomosed through end-to-end. The functional evaluation standard of finger replantation was used to evaluate the postoperative function. Results: Twenty-four cases were finally survived. Two flaps occurred vascular crisisin within 48 h after operation,one of which was survived after anti-vasospasm treatment and changing dressing,another was replanted finger for failed to survive. One had infection and healed after changing dressing. Twenty-four cases were followed up from 3 to 38 months with an average of 16.5 months. The appearance and texture of flaps were satisfactory,and the superficial senses of pain and touch were recovered,and two-point discrimination was 5.5 to 11 mm(averaged 7.4 mm). According to functional evaluation standard finger replantationissued by Hand Surgery Association of Chinese Medical Association,8 cases got excellent results,14 good and 2 poor. Conclusion: The free flap pedicled with supracarpal cutaneous branch of ulnar artery can be used in complex finger replantation with skin and vessels defect,which can extend operation indications,recover function and appearance for maximum.