Clinical effects of free dorsal interosseous artery perforator flaps in repairing multi-finger skin and soft tissue defects
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摘要:
目的 探讨采用游离骨间背动脉穿支皮瓣修复多指皮肤软组织缺损的临床效果。 方法 该研究为回顾性观察性研究。2020年4月—2022年6月，重庆长城骨科医院手显微外科收治7例多指皮肤软组织缺损患者，其中男4例、女3例，年龄27~54岁。7例患者共18指受伤，其中4指受累者1例、3指受累者2例、2指受累者4例。Ⅰ期清创后皮肤软组织缺损面积为3.0 cm×2.0 cm~7.5 cm×3.0 cm。所有患者均行Ⅰ期清创、Ⅱ期骨间背动脉穿支皮瓣移植修复创面、Ⅲ期皮瓣断蒂及分指。皮瓣切取面积为4.0 cm×2.5 cm~10.5 cm×3.5 cm。将骨间背动脉与指固有动脉进行端端吻合，将2条骨间背动脉的伴行静脉与手指2条皮下浅静脉进行端端吻合。采用充分减张后皮下缝合的方法处理供区。观察Ⅲ期术后皮瓣成活情况。Ⅲ期术后每3个月进行1次随访，观测手指术区外观、质地、感觉情况，手指关节活动度，供区创面愈合情况。末次随访时，根据中华医学会手外科学会上肢部分功能评定试用标准评定手指功能。 结果 7例患者Ⅲ期术后皮瓣均成活。Ⅲ期术后随访6~36个月，仅3例患者皮瓣臃肿，于3个月及以后行皮瓣减容手术，其余患者手指外观恢复良好；6例患者供区仅遗留线性瘢痕，1例患者出现供区瘢痕增生且经激光治疗后明显好转。末次随访时，手指功能评定为优者5例、良者2例。 结论 采用以多条骨间背动脉穿支为蒂的皮瓣修复多指皮肤软组织缺损，术中仅吻合一套血管且不损伤主干血管，降低了术后血管危象的发生率；分指手术操作简单，术后供受区外观和功能较佳，值得临床推广。 Abstract:Objective To investigate the clinical effects of free dorsal interosseous artery perforator flaps in repairing multi-finger skin and soft tissue defects. Methods The study was a retrospective observational study. From April 2020 to June 2022, 7 patients with multi-finger skin and soft tissue defects were admitted to the Department of Hand Microsurgery of the Chongqing Great Wall Orthopaedic Hospital, including 4 males and 3 females, aged 27 to 54 years. A total of 18 fingers were injured in 7 patients, of which 4 fingers were involved in 1 case, 3 fingers were involved in 2 cases, and 2 fingers were involved in 4 cases. The area of skin and soft tissue defects after stage Ⅰ debridement ranged from 3.0 cm×2.0 cm to 7.5 cm×3.0 cm. All the patients underwent stage Ⅰ debridement, stage Ⅱ interosseous dorsal artery perforator flap transplantation to repair the wound, and stage Ⅲ flap pedicle division and finger-split. The incision area of the flap was 4.0 cm×2.5 cm to 10.5 cm×3.5 cm. The interosseous dorsal artery was anastomosed with the proper digital artery by end to end, and the concomitant veins of 2 interosseous dorsal arteries were anastomosed with 2 superficial subcutaneous veins of the fingers by end to end. The donor area was treated by subcutaneous suture after full reduction of tension. The survival of flap after stage Ⅲ was observed. Follow-up was conducted once every 3 months after the stage Ⅲ operation to observe the appearance, texture, sensation of the operative areas in fingers, the range of motion of the finger joint, and the wound healing of the donor area. At the last follow-up, the function of fingers was assessed according to the trial standard of upper limb partial function assessment of the Hand Surgery Society of Chinese Medical Association. Results All the flaps in 7 patients survived after stage Ⅲ operation. During follow-up of 6 to 36 months after stage Ⅲ operation, only 3 patients with bloated flap underwent the flap volume reduction operation in 3 months and later, and the finger appearance in the other patients recovered well. Only linear scar remained in the donor areas of 6 patients; 1 patient had scar hyperplasia in the donor area, which was significantly improved after laser treatment. At the last follow-up, the finger function was evaluated as excellent in 5 cases and good in 2 cases. Conclusions The flaps pedicled with multiple interosseous dorsal artery perforators were used to repair multi-finger skin and soft tissue defects, and only one set of blood vessel needs to be anastomosed during the operation without damaging the main vessels, which reduces the incidence of postoperative vascular crisis. Besides, the procedure of finger-splitting operation is simple and the appearance and function in the donor and recipient areas are good. This method is worthy of clinical promotion. -
Key words:
- Finger injuries /
- Perforator flap /
- Surgical flaps /
- Microsurgery /
- Skin and soft tissue defects /
- Wound repair
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参考文献
(30) [1] 周望高,张振伟,余少校,等.骨间后动脉Flow-through穿支皮瓣修复伴有指端血运障碍的指背软组织缺损[J].中华显微外科杂志,2022,45(3):284-288.DOI: 10.3760/cma.j.cn441206-20210121-00023. [2] 刘铁虎.3种皮瓣修复手指软组织缺损的疗效比较[J].临床骨科杂志,2023,26(5):669-673.DOI: 10.3969/j.issn.1008-0287.2023.05.016. [3] 牟勇,张钊,徐世明,等.游离骨间背动脉穿支皮瓣修复手背侧皮肤软组织缺损[J].实用手外科杂志,2019,33(2):131-133,149.DOI: 10.3969/j.issn.1671-2722.2019.02.001. [4] 周维,李学渊,胡浩良.高频超声辅助下前臂中下段游离骨间后动脉穿支皮瓣修复手指软组织缺损[J].中华显微外科杂志,2020,43(3):285-288.DOI: 10.3760/cma.j.cn441206-20200216-00062. [5] 王珏,闵沛如,肖文天,等.前额带蒂皮瓣断蒂前皮瓣血循环训练方法的对比研究[J].组织工程与重建外科杂志,2022,18(5):415-418.DOI: 10.3969/j.issn.1673-0364.2022.05.008. [6] 潘生德,顾玉东,侍德.中华医学会手外科学会上肢部分功能评定试用标准[J].中华手外科杂志,2000(3):130.DOI: 10.3760/cma.j.issn.1005-054X.2000.03.003. [7] 北京积水潭医院《手外科学》编写组.手外科学[M].北京:人民卫生出版社,1978:150-153. [8] 曾繁云,吴海建,卢致金,等.髂腹股沟带蒂皮瓣修复全拇指脱套伤[J].临床骨科杂志,2023,26(6):801-803.DOI: 10.3969/j.issn.1008-0287.2023.06.012. [9] 黄悦,林枫,郝春雨,等.改形设计指固有动脉岛状皮瓣修复复杂指端缺损的疗效[J].中华烧伤与创面修复杂志,2023,39(10):947-952.DOI: 10.3760/cma.j.cn501225-20230109-00008. [10] 顾玉东.指部皮肤缺损的修复原则[J].中华手外科杂志,2012,28(3):130.DOI: 10.3760/cma.j.issn.1005-054X.2012.03.002. [11] 王辉,王海峰,白卫飞,等.两种同指带蒂皮瓣修复拇指指端或指腹创面的比较[J].中华显微外科杂志,2024,47(1):71-77.DOI: 10.3760/cma.j.cn441206-20230814-00013. [12] 孙旭,殷宗琦,郑捷新,等.基于指动脉背侧支供血的蝶形皮瓣与螺旋桨皮瓣修复手指掌侧创面疗效的对比研究[J].中华烧伤与创面修复杂志,2023,39(6):552-557.DOI: 10.3760/cma.j.cn501225-20220714-00294. [13] 龙国华.改良指动脉终末背侧支邻指皮瓣在修复指端缺损中的临床应用[J].实用手外科杂志,2023,37(4):582-583.DOI: 10.3969/j.issn.1671-2722.2023.04.037. [14] 滕道练,李甲,王大伟,等.趾腓侧游离皮瓣修复指端缺损的临床效果[J].中华整形外科杂志,2023,39(9):960-965.DOI: 10.3760/cma.j.cn114453-20230526-00116. [15] 李锦,武海波,金光哲,等.第2趾胫侧趾背动脉皮瓣与第2趾胫侧趾底固有动脉皮瓣修复手指皮肤软组织缺损疗效的对比研究[J].中华烧伤与创面修复杂志,2022,38(10):937-943.DOI: 10.3760/cma.j.cn501120-20210909-00310. [16] 董书男,刘承伟,江吉勇,等.趾腓侧分叶穿支皮瓣拆分移植修复多发指端缺损[J].中华显微外科杂志,2024,47(1):44-47.DOI: 10.3760/cma.j.cn441206-20231102-00066. [17] 张驰,孙广峰,游兴,等.游离骨间后动脉穿支皮瓣在小面积手部皮肤软组织缺损中的应用[J].中华整形外科杂志,2021,37(9):1007-1012.DOI: 10.3760/cma.j.cn114453-20210316-00115. [18] 张海瑞,张栋梁,闫晓慧,等.携带浅静脉的游离骨间后动脉穿支皮瓣整复口周严重瘢痕增生挛缩的临床效果[J].中华烧伤与创面修复杂志,2023,39(12):1175-1179.DOI: 10.3760/cma.j.cn501225-20231031-00162. [19] 张永超,安宝鑫,韩海元,等.游离同侧骨间背动脉多个穿支皮瓣修复多指皮肤缺损[J].创伤外科杂志,2024,26(1):61-66.DOI: 10.3969/j.issn.1009-4237.2024.01.013. [20] 吴穷,江吉勇,范江来,等. 游离骨间后动脉穿支皮瓣在手指缺损创面的临床使用[J]. 中国骨伤,2023,36(8):714-718. DOI: 10.12200/j.issn.1003-0034.2023.08.004. [21] 刘新益,巨积辉,蒋国栋,等.以骨间背动脉为蒂的双叶皮瓣修复手部皮肤缺损[J].中国美容整形外科杂志,2021,32(7):385-387.DOI: 10.3969/j.issn.1673-7040.2021.07.001. [22] 林琅山,陈峰,杨正禄.骨间背侧动脉穿支游离皮瓣修复手指软组织缺损的临床研究[J].中国实用医药,2020,15(13):93-95.DOI: 10.14163/j.cnki.11-5547/r.2020.13.040. [23] 刘海棠,叶锦发,谢沛军,等.微型游离骨间背动脉穿支皮瓣修复手指皮肤软组织缺损[J].实用手外科杂志,2021,35(2):207-210.DOI: 10.3969/j.issn.1671-2722.2021.02.022. [24] 李师江,李同春,吴韦强.前臂骨间后动脉穿支皮瓣逆行修复手背创面的临床应用及手术技巧[J].实用手外科杂志,2023,37(1):80-82.DOI: 10.3969/j.issn.1671-2722.2023.01.023. [25] 刘育杰,丁小珩,焦鸿生,等. 多种游离微型穿支皮瓣修复手指皮肤缺损的疗效分析[J]. 中国美容整形外科杂志,2017,28(2):78-82,128. DOI: 10.3969/j.issn.1673-7040.2017.02.004. [26] 陆浩,薛明宇,强力,等.以骨间后动脉穿支为蒂的V-Y接力皮瓣修复手背部创面[J].中华手外科杂志,2023,39(1):40-43.DOI: 10.3760/cma.j.cn311653-20220317-00073. [27] 方杰,董自强,齐伟亚,等.多种形式显微修薄穿支皮瓣在四肢创面修复中的应用[J].中华整形外科杂志,2023,39(9):947-952.DOI: 10.3760/cma.j.cn114453-20230217-00035. [28] 方鑫,胡沣,陈前永,等.前臂游离骨间后动脉分叶穿支皮瓣修复多指软组织缺损[J].创伤外科杂志,2022,24(6):420-423.DOI: 10.3969/j.issn.1009-4237.2022.06.005. [29] 杨欣 带蒂皮瓣微循环监测及早期断蒂的实验研究与临床应用 北京 中国协和医科大学 1993 杨欣.带蒂皮瓣微循环监测及早期断蒂的实验研究与临床应用[D]. 北京:中国协和医科大学,1993.
[30] 李匡文,刘鸣江,刘俊,等. 游离双叶骨间后动脉皮瓣修复两个手指软组织缺损[J]. 中华显微外科杂志,2012,35(5):378-380,445. DOI: 10.3760/cma.j.issn.1001-2036.2012.05.008. -
1 右前臂游离骨间背动脉穿支皮瓣修复患者右手第2~5指皮肤软组织缺损创面的效果。1A.急诊入院时第2~5指中末节皮肤软组织缺损；1B.急诊X线片示中环指指骨骨折；1C.Ⅰ期术后1 d，X线片示中环指远指间关节融合及克氏针固定后；1D.Ⅰ期术后7 d，多次换药后创面干燥无渗出；1E.Ⅱ期皮瓣移植术前彩色多普勒超声定位骨间背动脉穿支，见穿支粗大；1F.Ⅱ期术中皮瓣切取；1G.Ⅱ期术中血管吻合后情况；1H.Ⅱ期术后即刻皮瓣血运良好；1I.Ⅱ期术后7 d，X线片示克氏针固定稳定；1J.Ⅱ期术后3周皮瓣完全成活；1K.Ⅲ期分指术后即刻，皮瓣稍臃肿；1L.Ⅲ期术后随访20个月，X线片示骨折愈合良好；1M、1N.分别为Ⅲ期术后随访20个月手指伸直和屈曲活动情况，手指外观和关节活动度良好；1O.Ⅲ期术后24个月随访，供区仅存留线性瘢痕
注：图1G中蓝色箭头指示皮瓣静脉与中指尺侧皮下浅静脉吻合，红色箭头指示皮瓣动脉与中指尺侧指固有动脉吻合
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