吻合皮神经的游离前臂双静脉动脉化皮瓣修复手指皮肤缺损

目的：探讨吻合皮神经的游离前臂双静动脉化皮瓣的临床应用。方法：应用游离前臂双静动脉化皮瓣修复16例16指伴有深部组织外露的皮肤缺损，在切取皮瓣时，找到包含在皮瓣内的皮神经支，与创面内神经残端吻合。结果：16例16指皮瓣全部成活，5例于皮瓣中远端出现张力性小水泡。16例患者均获得随访，随访时间3～6个月，平均（4．5±0．2）个月。皮瓣1．5个月时即开始有明显保护性触觉。6个月时皮瓣浅痛觉部分恢复，二点分辨觉14～17mm，皮瓣质地适中，弹性较好，2例色素沉着，其余15例颜色与周边皮肤无明显差异。结论：游离前臂双静脉动脉化皮瓣能够较好地修复中小型手指创面，皮瓣内皮神经支与创面内神经残端吻合有助于皮瓣感觉的恢复。

Repair of finger skin defects by arterized double-vein free flap of the forearm with anastomosis of cutaneous nerve

Objective：To explore the clinical use of arterized double-vein free flap of the forearm with anastomosis of cutaneous nerve. Methods： Arterized double-vein free flaps of the forearm were used to repair sixteen patients with 16 finger skin defects and exposure of deep tissues. The skin nerve branches in the flaps were found when harvesting the flap,and were anastomosed to the nerve stump in defects. Results：A total of 16 cases of 16 finger flaps survived,but 5 cases were found to have small tension blisters in the distal end of flaps. All patients were followed up for 3 to 6 months （ mean = 4.5 months）. The skin flaps started to have protective sense of touch at 1.5 months and partly recovered the superficial sense of pain at 6 months. Furthermore, the flaps had moderate texture and relatively favorable, elasticity with the two-point discrimination value being 4-17 mm. Two cases were found to have pigmentation,while the remaining 15 cases showed no significant difference in color between the flaps and the peripheral skin. Conclusion：Arterized double-vein free flap of the forearm with anastomosis of cutaneous nerve may be effective in repairing middle-small finger defects. Moreover, the anastomosis of skin nerve branches and the nerve stump in defects contributed to the recovery of flap sense.