Effects of free superficial peroneal artery perforator flap in repairing small and medium-sized thermal crush injury wounds in the hand
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摘要:
目的 探讨采用游离腓浅动脉穿支皮瓣修复手部中小面积热压伤创面的手术方法及临床效果。 方法 采用回顾性观察性研究方法。2018年8月—2021年12月，苏州瑞华骨科医院收治12例符合入选标准的手部中小面积热压伤患者（19处创面），其中男5例、女7例，年龄30~54岁。创面面积为2.5 cm×2.0 cm~14.0 cm×3.5 cm，均采用一侧小腿游离腓浅动脉穿支皮瓣（包括于同一供区切取的单块皮瓣、多块皮瓣、一蒂多瓣）修复，皮瓣面积为3.5 cm×3.0 cm~16.0 cm×4.0 cm。将供区创面直接缝合。术后观察皮瓣是否出现血管危象、皮瓣成活情况。随访观测皮瓣修复处质地、外形、色泽、有无色素沉着、感觉、两点辨别觉，供受区瘢痕有无增生、疼痛。于末次随访时，采用综合评价量表评价皮瓣修复疗效，采用美国手外科学会推荐的总主动活动度系统评定方法评定保留指体关节伸屈功能。 结果 1块皮瓣术后第1天出现动脉危象，经及时探查后成活，其余18块皮瓣术后均顺利成活。术后随访4~24个月显示，皮瓣修复处质地、外形良好，色泽接近受区周围正常皮肤，无色素沉着，均恢复保护性感觉，但无两点辨别觉；供受区瘢痕无明显增生、疼痛。末次随访时，皮瓣修复疗效评定：优者3块、良者16块；保留指体关节伸屈功能评定：优者8指、良者9指、可者2指。 结论 腓浅动脉穿支皮瓣血供充足可靠，可于1个供区切取多块该类皮瓣或一蒂多瓣。采用该皮瓣修复手部中小面积热压伤创面，供区损伤小，术后皮瓣外形、质地好。 Abstract:Objective To investigate the surgical methods and clinical effects of free superficial peroneal artery perforator flap in repairing small and medium-sized thermal crush injury wounds in the hand. Methods A retrospective observational study was conducted. From August 2018 to December 2021, 12 patients (19 wounds) with small and medium-sized thermal crush injury in the hand who met the inclusion criteria were hospitalized in Suzhou Ruihua Orthopaedic Hospital, including 5 males and 7 females, aged from 30 to 54 years. The area of the wound was from 2.5 cm×2.0 cm to 14.0 cm×3.5 cm, and all the wounds were repaired by using free superficial peroneal artery perforator flaps from lower leg on one side (including single flap, multiple flaps, and multiple flaps with one pedicle resected from the same donor site). The area of the flap was from 3.5 cm×3.0 cm to 16.0 cm×4.0 cm. The wound in the donor site was sutured directly. The vascular crisis and survival of the flap were observed after operation. The texture, appearance, color, hyperpigmentation, sensation, and two-point discrimination of the flap repaired area were followed up, as well as the hyperplasia of scar and pain condition in the donor and recipient sites. At the last follow-up, the curative effect of flap repair was evaluated by the comprehensive evaluation scale, and the extension and flexion functions of the reserved digital joint were evaluated by the total active movement systematic evaluation method recommended by American Academy for Surgery of Hand. Results One flap developed arterial crisis on the first day after operation but survived after timely exploration. The other 18 flaps survived successfully after operation. Follow-up of 4 to 24 months after operation showed good texture and appearance in the flap repaired area; the color of the flap repaired area was similar to that of the normal skin around the recipient site, without pigmentation; the protective sensation was restored in all cases, but there was no two-point discrimination; there was no obvious hypertrophic scarring or pain in the donor or recipient site. At the last follow-up, the curative effect of flap repair was evaluated with 3 flaps being excellent and 16 flaps being good; the extension and flexion functions of the reserved digital joint were also assessed, being excellent in 8 fingers, good in 9 fingers, and fair in 2 fingers. Conclusions The blood supply of superficial peroneal artery perforator flap is sufficient and reliable, and multiple flaps of this type or multiple flaps with one pedicle can be resected from one donor site. The use of this flap to repair small and medium-sized thermal crush injury wounds in the hand results in minimal damage to the donor area, and good postoperative appearance and texture of the flap. -
Key words:
- Burns /
- Surgical flaps /
- Hand injuries /
- Microsurgery /
- Wound repair
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参考文献
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1 术前彩色多普勒超声在A、C线之间定位腓浅动脉穿支
注：C线为腓骨体表投影，是腓骨头与外踝尖连线；B线为腓浅动脉体表投影，为C线向前平移1.5 cm所得；A线为B线向前平移1.5 cm所得
2 游离左小腿1块腓浅动脉穿支皮瓣修复例1患者右手1处中等面积热压伤创面。2A.皮瓣修复术前，右手背及中指背侧皮肤坏死；2B.皮瓣切取中；2C.皮瓣修复术后即刻；2D.供区创面经皮肤缝合器（白色区域）直接缝合后即刻；2E.术后9个月，皮瓣修复处外观良好；2F.术后9个月，手指伸直功能正常；2G.术后9个月，手指屈曲功能正常；2H.术后9个月，供区遗留线性瘢痕
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