游离多块小腿前外侧穿支皮瓣一期修复单手多指创面
One-stage reconstruction of multiple digital wounds in single hand with multiple free anterolateral perfora-tor flaps of calf
李友 1唐林峰 1熊胜 1杜伟伟 1刘海亮 1程贺云 1张广亮 1巨积辉 1侯瑞兴1
作者信息
- 1. 苏州瑞华骨科医院手外科,江苏 苏州 215104
- 折叠
摘要
目的 探讨游离多块小腿前外侧穿支皮瓣在修复单手多指创面中的应用价值,并观察其治疗效果.方法 2020年8月-2022年3月,苏州瑞华骨科医院手外科收治12例35指软组织缺损患者.患者男10例,女2例,年龄25～58岁.其中1例5指、3例4指、2例3指和6例2指软组织缺损.清创后创面大小1.2 cm× 1.2 cm～7.0 cm×3.5 cm.术中探查见其中24块皮瓣血管穿支源自腓浅动脉、7块源自腓动脉、4块源自胫前动脉,术中皮瓣穿支动脉及伴行静脉与受区指掌侧固有动脉以及掌侧或背侧皮下静脉相吻合;皮瓣切取面积1.5 cm×1.5 cm～7.5 cm×4.0 cm;术中均未切取神经,小腿供区均直接缝合.术后门诊定期随访,随访采用皮瓣综合评价量表评定供、受区状况.结果 本组12例35指软组织缺损应用小腿前外侧皮瓣进行修复,术后皮瓣成活35指,皮瓣成活率100％.术后早期指导患者开展功能训练,追踪随访6～24个月,平均为11个月.25例皮瓣略臃肿,于3个月后行皮瓣修整术,剩余皮瓣外观与质地良好.术后6个月,所有皮瓣均可恢复部分深、浅感觉和触觉功能;供区小腿切口一期愈合,无功能障碍.皮瓣综合评价量表评定本组修复的35指中优28指、良7指,优良率为100％.结论 采用游离多块小腿前外侧穿支皮瓣修复单手多指创面,具有切取方便、一期修补多指创面、供区损伤小等优点,临床疗效满意.
Abstract
Objective To explore the application value and treatment effects of multiple free anterolateral perforator flaps of calf for reconstruction of multiple digital wounds in single hand.Methods From August 2020 to March 2022,12 patients with soft tissue defects in 35 digits were treated in Department of Hand Surgery,Suzhou Ruihua Orthopaedic Hospital.Ten patients were male and 2 were female,aged 25 to 58 years old.Of the patients,1 had soft tissue defects in 5 digits,3 in 4 digits,2 in 3 digits and 6 in 2 digits.The size of defects was from 1.2 cm × 1.2 cm to 7.0 cm×3.5 cm after debridement.The vascular perforators discovered from intraoperative explorations were found originating from the superficial peroneal artery in 24 flaps,from the peroneal artery in 7 flaps and from the anterior tibial artery in 4 flaps.During surgery,the perforator artery and accompanying veins of the flaps were anastomosed with the proper digital artery and palmar or dorsal subcutaneous veins in the recipient site,respectively.The size of the flaps was from 1.5 cm×1.5 cm to 7.5 cm×4.0 cm.No nerve was affected in the surgery.The wound at donor sites in the calf was sutured directly.Regular postoperative follow-ups were conducted at outpatient clinics.The comprehensive evaluation scale of flap was used to assess the conditions of the donor and recipient sites.Results In this study,all 35 soft tissue defects of digits in 12 patients were reconstructed by the anterolateral per-forator flaps of calf.All the 35 flaps survived after surgery,with a 100％of survival rate.The patients were instruct-ed to carry out early functional training after surgery.Follow-up lasted 6 to 24 months,with an average of 11 months.Twenty-five flaps were found in slightly swollen,and further flap thinning surgery were carried out 3 months after the primary surgery,while the rest of the flaps had good appearance and texture.At 6 months after surgery,all flaps recovered a partial deep and shallow sensory and sense of touch.All wound at donor sites in calf had one-stage healing without dysfunction.The comprehensive evaluation scale was excellent in 28 flaps and good in 7 flaps.The excellent and good rate was 100％.Conclusion It is an effective method to use multiple free anterolateral perforator flaps of calf to reconstruct multiple digit defects in single hand.The flaps can be conveniently harvested and the multiple digital defects in single hand can be reconstructed in primary surgery with small damages to the donor sites and together with satisfactory clinical outcomes.
关键词
小腿前外侧穿支皮瓣/手指损伤/移植/显微外科技术Key words
Anterolateral perforator flaps of calf/Digit injury/Transfer/Microsurgical technique引用本文复制引用
基金项目
苏州市重点病种诊疗技术专项项目(LCZX202026)
苏州市医疗卫生科技创新项目(SKJY2021021)
姑苏卫生人才培养项目(GSWS2020116)
吴中区科技计划项目(WZYW2021001)
吴中区科技计划项目(WZYW2022015)
出版年
2024
NETL
NSTL
万方数据