目的 探讨分析多种Flow-through皮瓣修复伴指掌侧固有动脉缺损创面的疗效。方法 回顾性分析2019年1月-2023年1月，徐州仁慈医院手外科采用骨间后动脉穿支皮瓣、静脉皮瓣、桡动脉掌浅支蒂腕横纹皮瓣和(足母)趾"C"形皮瓣Flow-through形式修复手指组织缺损合并指掌侧固有动脉缺损的患者22例，其中男15例，女7例，年龄21～61岁，平均39。5岁;指别:拇指1例，示指6例，中指8例，环指5例，小指2例;侧别:左侧 10 例，右侧 12 例。创面大小 1。5 cm × 1。5 cm～4。5 cm × 3。0 cm，皮瓣大小为 2。0 cm × 1。5 cm～5。0 cm × 4。0 cm，供区创面予以直接缝合关闭或换药愈合。术后1、2、3、6、12个月通过门诊、电话、微信等方式定期随访患者。观察并记录皮瓣成活情况、术后供区和受区并发症、患者满意度、关节活动度。结果 20例皮瓣均顺利成活，无血管危象发生，供区伤口均Ⅰ期愈合，受区伤口除2例静脉皮瓣经换药愈合外均Ⅰ期愈合。2例静脉皮瓣术后出现张力性水疱，经换药愈合。22例均获得随访，随访时间6～24个月，平均10。3个月。1例骨间后动脉穿支皮瓣术后外观臃肿，指骨间关节活动受限，但患者拒绝修薄手术;1例静脉皮瓣在后期手术中予以瘢痕修整处理;余20例患者均对皮瓣外观恢复表示满意，无再次整形修薄需求。末次随访时按照中华医学会手外科学会上肢部分功能评定试用标准进行评价，其中优12例，良9例，差1例。皮瓣的静态TPD平均为6。9(5～11)mm，单丝触觉(SWM)平均为4。47(3。61～6。65)。结论 4种皮瓣均可一次手术完成合并动脉主干缺损的手指创面修复，获得相对满意的效果，可根据具体情况个性化选择手术治疗方案。
Investigation of curative effect of various types of Flow-through flaps in reconstruction of wounds with defect of palmar proper digital artery
Objective To investigate the therapeutic efficiency of various types of Flow-through flap in the reconstruction of soft tissue defect with defect of proper palmar digital artery.Methods Retrospective analysis was carried out on 22 patients who were treated with perforator flap of posterior interosseous artery,venous flap,the superficial palmar branch of radial artery flap,and"C"shaped flap of the great toe for soft tissue defects of hands with defects of palmar proper digital artery in the Department of Hand Surgery of Xuzhou Renci Hospital from January 2019 to January 2023.The patients were 15 males and 7 females with an average age of 39.5(21-61)years old.The injured digits were 1 thumb,6 index fingers,8 middle fingers,5 ring fingers and 2 little fingers.Ten injuries were of left hand and 12 of right hand.The wound size was 1.5 cm × 1.5 cm-4.5 cm ×3.0 cm,and the flap size was 2.0 cm × 1.5 cm-5.0 cm × 4.0 cm.The donor site wound were directly sutured and closed or treated by dressing changes to heal.Postoperative follow-ups were arranged at 1,2,3,6 and 12 months after surgery at outpatient clinic,through telephone or WeChat interviews.The flap survival,postoperative complications at donor and recipient sites,patient satisfaction and range of motion of interphalangeal joint were observed and recorded.Results Twenty flaps survived uneventfully.Tension vesicles appeared on the 2 arterialised venous flaps and healed after dressing changes.All donor sites healed uneventfully.All patients were included in the postoperative follow-up for an aver-age of 10.3(6-24)months.Appearance of the perforator flaps of posterior interosseous artery was bloated and the movement of interphalangeal joint was limited in 1 digit,however the patient refused a further flap thinning surgery.Scar dissection was performed on 1 of the venous flaps in stage Ⅱ surgery.The rest of 20 patients were satisfied with the appearance of flaps hence no further thinning surgery was performed.According to Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,12 cases were evaluated as excellent,9 cases as good,and 1 case as poor at the last follow-up.The mean static TPD was found at 6.9(5-11)mm,and the average Semmes-Weinstein monofilament(SWM)test was found at 4.47(3.61-6.65).Conclusion The 4 types of perforator flap can be employed in the reconstruction of digital defect with defect of palmar proper digital artery in a one-stage surgery with satisfactory outcomes.Surgeons can accordingly make individualised surgical plans as required for the patients.
Flow-through flapDigit injuryProper palmar digital arteryMicrosurgical operation
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