尺动脉近端穿支皮瓣联合髂骨移植再造部分拇或手指的临床效果

张玉军; 巨积辉; 赵强; 王本元; 程贺云; 王桂洋; 侯瑞兴

doi:10.3760/cma.j.cn501120-20210707-00238

尺动脉近端穿支皮瓣联合髂骨移植再造部分拇或手指的临床效果

doi: 10.3760/cma.j.cn501120-20210707-00238

苏州大学瑞华骨科医院手外科，苏州　　215104

基金项目:

苏州市科技计划项目 SYSD2018052

详细信息

通讯作者:
巨积辉，Email：jjh2006@263.net

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出版历程
- 收稿日期: 2021-07-07
- 网络出版日期: 2022-10-24

Clinical effects of proximal ulnar artery perforator flap combined with iliac bone graft in the reconstruction of subtotal thumb or finger defects

Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China

Funds:

Suzhou Science and Technology Program SYSD2018052

More Information

Corresponding author: Ju Jihui, Email: jjh2006@263.net

摘要

摘要: 目的探讨应用尺动脉近端穿支皮瓣联合髂骨移植再造部分拇、手指的临床效果。方法采用回顾性观察性研究方法。2016年8月—2019年8月，苏州大学附属瑞华医院收治7例符合入选标准的机械损伤致拇、手指毁损患者，其中男6例、女1例，年龄46~58岁。均采用髂骨移植恢复指体长度，切取的髂骨长度为2.0~3.0 cm，植骨后，患指皮肤软组织缺损面积为2.8 cm×2.2 cm~6.0 cm×3.2 cm，采用面积为3.0 cm×2.4 cm~6.5 cm×3.5 cm的游离尺动脉近端穿支皮瓣覆盖创面；将髂骨部供区和皮瓣供区创面直接缝合。术后1周观察皮瓣的成活情况，术后2周观察供区创面愈合情况。随访时观察和评定患指外观和感觉功能，骨愈合情况及供区创面瘢痕增生情况；末次随访时，参照中华医学会手外科学会上肢部分功能评定试用标准评价患指的功能恢复情况。结果术后1周，皮瓣均成活。术后2周，髂骨部及前臂供区创面均愈合。随访5~13个月，皮瓣外观良好，无明显色素沉着；5例患者感觉功能恢复到S₂级，2例患者感觉功能恢复到S₀级；移植的髂骨均骨性愈合，无明显骨吸收；供区创面愈合良好，仅有轻度瘢痕形成。末次随访时，再造指外形与健侧指接近，功能评定：优3例、良4例。结论应用尺动脉近端穿支皮瓣联合髂骨移植再造部分拇、手指，可恢复部分外形及功能，供区损伤较小，是对再造指外观及功能期望值不高者的一种较好选择。
- 显微外科手术 /
- 外科皮瓣 /
- 指损伤 /
- 组织移植 /
- 创面修复
Abstract: Objective To explore the clinical effects of proximal ulnar artery perforator flap combined with iliac bone graft in the reconstruction of subtotal thumb or finger defects. Methods A retrospective observational study was conducted. From August 2016 to August 2019, 7 patients with thumb or finger defects caused by mechanical damage who met the inclusion criteria were admitted to Ruihua Affiliated Hospital of Soochow University, including 6 males and 1 female, aged 46 to 58 years. Their length of fingers was repaired with iliac bone, with length of 2.0 to 3.0 cm. After the bone graft, the skin defect area of the affected finger ranged from 2.8 cm×2.2 cm to 6.0 cm×3.2 cm. Then the free proximal ulnar artery perforator flap with area of 3.0 cm×2.4 cm to 6.5 cm×3.5 cm was used to cover the wounds. The wounds in donor sites of iliac crest and flap were directly sutured. The survival of flap in one week post surgery and the donor site wound healing in 2 weeks post surgery were observed, respectively. During the follow-up, the appearance and sensory function of the affected finger, bone healing, and scar hypertrophy of wound in the donor site were observed and evaluated. At the last follow-up, the functional recovery of the affected finger was evaluated with trial standard for the evaluation of functions of the upper limbs of the Hand Surgery Society of Chinese Medical Association. Results In one week post surgery, all the flaps survived. In 2 weeks post surgery, the iliac bone and the wounds in forearm donor site healed. During the follow-up of 5 to 13 months, the flap was good in appearance, without obvious pigmentation; the sensory recovery reached level S₂ in 5 patients and S₀ in 2 patients; all the grafted iliac bones were bony union without obvious resorption; the wounds in donor site healed well, with only mild scar formation. At the last follow-up, the shape of the reconstructed finger was close to the healthy finger, and the functional evaluation results were excellent in 3 cases and good in 4 cases. Conclusions The use of proximal ulnar artery perforator flap combined with iliac bone graft to reconstruct subtotal thumb or finger can partially restore part of the appearance and function, with less damage to the donor site. It is a good choice for patients who have low expectations of appearance and function for the reconstructed finger.
- Microsurgery /
- Surgical flaps /
- Finger injuries /
- Tissue transplantation /
- Wound repair
所有作者均声明不存在利益冲突

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1 游离左尺动脉近端穿支皮瓣联合髂骨移植再造部分左拇指。1A.术前，左拇指近末节部分皮肤软组织发黑、坏死；1B.术中，左拇指末节指骨缺血、坏死；1C.切除左拇指坏死组织后见指骨及皮肤软组织缺损；1D.切取髂骨；1E.左尺动脉近端穿支皮瓣切取中；1F.髂骨克氏针交叉固定及皮瓣移植中；1G.术后2周，皮瓣成活；1H.术后3个月，X线片示骨愈合良好，骨折线消失；1I.术后3个月，X线片示内固定取出后无骨吸收，左、右图分别为正位、斜位；1J、1K、1L.均为术后13个月随访图，依次分别显示左拇指皮瓣外观、对指功能良好，左拇指长度与健侧接近，左前臂供区瘢痕轻微

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