趾腓侧皮瓣与腓动脉穿支皮瓣修复手部缺损疗效比较

目的：探讨游离趾腓侧皮瓣与腓动脉穿支皮瓣修复手部皮肤软组织缺损的设计切取方法及临床疗效。方法2009年2月—2013年1月，对46例手部不同部位、形态的皮肤软组织缺损，分别采用游离趾腓侧皮瓣修复25例，游离腓动脉穿支皮瓣修复21例，皮肤缺损范围为1.5 cm＆#215;2.5 cm～3.0 cm＆#215;6.5 cm，根据受区皮肤软组织缺损大小、形状设计和切取皮瓣。结果本组46例皮瓣全部成活，1例出现静脉危象，经小切口放血后危象解除，皮瓣成活。术后随访6～12个月，手部整体外观、功能恢复良好，皮瓣感觉部分恢复，供区无并发症。结论应用游离趾腓侧皮瓣或腓动脉穿支皮瓣修复手部皮肤软组织缺损，可恢复手部良好的外观与功能。趾腓侧皮瓣皮肤质地、外观更接近正常手部掌侧皮肤；腓动脉穿支皮瓣可根据手部创面大小灵活切取，二者均可作为理想的游离皮瓣修复手部皮肤软组织缺损。

The effect comparison between fibular side flap of great toe and peroneal artery perforator flap to repair soft tissue defect

Objective To investigate the design, harvest, and clinical efficacy of the fibular side flap of the great toe and the peroneal artery perforator flap for the restoration of soft tissue defects of the hand. Methods From February 2009 to January 2009, a series of 46 cases with hand defects were included in this study. 25 cases were repaired with the fibular side flap of the great toe, while 21 cases were reconstructed with the peroneal artery perforator flap. The range of soft tissue defect was from 1.5 cm ＆#215;2.5 cm to 3.0 cm ＆#215;6.5 cm. The flaps were designed and harvested according to the size and shape of soft tissue defect. Results All flaps survived post-operation. While 1 case was presented with veneous crisis, and the flap survived after the bloodletting procedure. All patients were followed up from 6 to 12 months postoperatively. Both the aesthetic appearance and the function of the hand were restored after operation. The sensation of the flaps were partially recovered. No donor side morbidity was presented. Conclusion In terms of the management of soft tissue defects of the hand, both the fibular side flap of the great toe and the peroneal artery perforator flap are capable of restoring the aesthetic appearance and the function of the hand. The skin condition of the fibular side flap of the great toe is similar to the normal palmar skin. The peroneal artery perforator flap can be harvested flexibility according to the size and shapes of different defects. Both of the above-mentioned flaps are ideal approaches for the reconstruction of the soft tissue defects of the hand.