封闭负压引流结合掌背动脉穿支皮瓣、掌长肌腱移植修复手背复合组织缺损

目的探讨封闭负压引流(VSD)技术结合逆行掌背动脉穿支岛状皮瓣、掌长肌腱移植修复手背复合组织缺损的临床疗效。方法应用VSD技术结合逆行掌背动脉穿支岛状皮瓣、掌长肌腱移植修复11例手背复合组织缺损患者。组织缺损面积1.8 cm×2.0 cm~3.0 cm×6.0 cm,切取皮瓣面积2.0 cm×2.5 cm~3.5 cm×7.0 cm。结果切取第2掌背动脉穿支岛状皮瓣7例,第3掌背动脉穿支岛状皮瓣2例,第4掌背动脉皮瓣皮支岛状皮瓣2例。皮瓣全部成活,无皮瓣感染病例。患者均获得随访,时间7~25个月。伤指关节功能、皮瓣外形较满意。末次随访时按手指总主动活动度(TAM)标准评估伤指功能:优6例,良3例,中2例。结论 VSD可有效控制创面炎症,结合逆行掌背动脉穿支岛状皮瓣、掌长肌腱移植修复手背复合组织缺损,外形及功能恢复满意、血运可靠,是一种较好的修复方法。

Vacuum sealing drainage combined dorsal metacarpal artery perforator flap and palmaris longus tendon transplantation to repair complex tissue defect of dorsum of hand

Objective To investigate the therapeutic effect of vacuum sealing drainage ( VSD) combined with retro-grade dorsal metacarpal artery perforator flap and palmaris longus tendon transplantation to repair complex tissue de-fect of dorsum of hand. Methods 11 cases of complex tissue defect in the back of hand were treated by VSD com-bined with retrograde dorsal metacarpal artery perforator based island flap, palm long tendon transplantation. The tis-sue defect size was 1. 8 cm × 2. 0 cm~3. 0 cm × 6. 0 cm and the cutting flap size was 2. 0 cm × 2. 5 cm~3. 5 cm × 7. 0 cm. Results 7 flaps were based on the second dorsal metacarpal artery perforator, 2 flaps were based on the third dorsal metacarpal artery perforator, and 2 flaps were based on the fourth dorsal metacarpal artery perforator. All patients received follow-up for 7 ~25 months. All the flaps were survived with wonderful appearance and satisfied function of fingers. There was no infective case. According to the Total Active Motion ( TAM) criteria to evaluate the function of injury finger at the final follow-up,6 cases were graded as excellent,3 as good, 2 as fair. Conclusions VSD can valid control wound inflammation. The dorsal metacarpal artery perforator flap has good function,acceptable forma, and reliably blood supply. It is a good choice to use VSD combined with retrograde dorsal metacarpal artery perforator flap and palmaris longus tendon transplantation for resurfacing complex tissue defect of dorsum of hand.