第一掌骨背逆行筋膜皮瓣修复拇指皮肤缺损

目的介绍一种修复拇指皮肤缺损的新型逆行筋膜皮瓣。方法取１０只新鲜尸体手，从桡动脉灌注红色乳胶，对第一掌骨背及拇指指背软组织的血管进行显微解剖，根据其血管分布设计成第一掌骨背逆行筋膜皮瓣。自甲根部桡侧缘至第一掌骨同侧背侧缘的连线为轴心线，其蒂部宜设在拇指指间关节近侧１ｃｍ以近的轴心线上。结果第一掌骨背及拇指指背软组织的血供主要由拇指两条指掌侧固有动脉向指背侧发出的分支，在指背筋膜内与两侧指背动脉及桡神经浅支伴行血管（桡、尺侧各２条）形成的血管网提供。１９９６年２月～１９９７年９月，临床应用该皮瓣修复拇指皮肤缺损６例，皮瓣全部成活。结论第一掌骨背及拇指指背软组织血供丰富，可形成第一掌骨背逆行筋膜皮瓣。该皮瓣设计合理、血供可靠、操作简便，适用于修复拇指，尤其是拇指桡侧皮肤的缺损

Repair of the soft tissue defect of the thumb with reversed dorsal fasciocutaneous flap of the first metacarpal

Objective To introduce a new reversed fasciocutaneous flap for repair of the soft tissue defect of the thumb. Methods Ten hands of fresh adult cadavers were studied. Red latex was perfused into the radial artery to show the distribution and facilitate the microsurgical dissection of vessels at the dorsal aspect of the first metacarpal and the thumb. The reversed dorsal fasciocutaneous flap of the first metacarpal was designed according to the distribution of vessels, with axial line from the radial base of the thumb nail to radial dorsal side of the first metacarpal, and pedicle within 1cm proximal to the interphalangeal joint of the thumb. From February 1996 to September 1997, 6 cases of soft tissue loss of the thumb were repaired with this kind of flap. Results There is rich blood supply in the soft tissue at the dorsal aspect of the first metacarpal and the thumb, which comes mainly from vascular network formed by 2 digital valor arteries, 2 digital dorsal arteries, and concomitant vessels of the superficial branch of the radial nerve. All 6 flaps survived with satisfactory treatment outcome after a follow up of 3 to 10 months. Conclusions The reversed dorsal fasciocutaneous flap of the first metacarpal is practicable and valuable in repair of the soft tissue loss of the thumb, particularlly at the radial and dorsal aspect of the thumb.