第2掌背动脉穿支皮瓣接力示指背侧岛状皮瓣修复拇指创面的疗效

陈艳; 谢斌; 刘远俊; 吴健

doi:10.3760/cma.j.cn501225-20231202-00224

第2掌背动脉穿支皮瓣接力示指背侧岛状皮瓣修复拇指创面的疗效

doi: 10.3760/cma.j.cn501225-20231202-00224

陈艳¹,
谢斌²,
刘远俊²,
吴健^1, ,

1.
甘肃省人民医院烧伤科,兰州　　730000
2.
甘肃中医药大学第一临床医学院,兰州　　　　730099

基金项目:

甘肃省科技计划项目 23YFFA0050

兰州市科技计划项目 2023-ZD-29

甘肃省人民医院院内科研基金项目 23GSSYB-13

详细信息

通讯作者:
吴健,Email：2005yjswj@163.com

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出版历程
- 收稿日期: 2023-12-02

Effects of the second dorsal metacarpal artery perforator flap relaying the dorsal island flap of index finger in repairing thumb wounds

Chen Yan¹,
Xie Bin²,
Liu Yuanjun²,
Wu Jian^{1
, ,}

1.
Department of Burns, Gansu Provincial People's Hospital, Lanzhou 730000, China
2.
The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou 730099, China

Funds:

Gansu Provincial Science and Technology Plan Project 23YFFA0050

Lanzhou Science and Technology Plan Project 2023-ZD-29

Gansu Provincial People's Hospital Internal Medicine Research Fund Project 23GSSYB-13

More Information

Corresponding author: Wu Jian, Email: 2005yjswj@163.com

摘要

摘要: 目的探讨采用第2掌背动脉穿支皮瓣接力示指背侧岛状皮瓣修复拇指创面的疗效。方法该研究为回顾性观察性研究。2021年5月—2023年1月,甘肃省人民医院收治14例符合入选标准的拇指创面患者,其中男8例、女6例,年龄24~63岁。清创后创面面积为2.1 cm×1.2 cm~5.5 cm×3.5 cm。用示指背侧岛状皮瓣（切取面积为2.4 cm×1.5 cm~5.5 cm×3.5 cm）修复拇指创面,然后经同一切口切取第2掌背动脉穿支皮瓣（切取面积为2.7 cm×1.6 cm~5.7 cm×3.6 cm）修复示指供区创面,将手背供区创面直接缝合。术后观察皮瓣成活情况及手背供区创面愈合情况。随访患者手背供区创面情况,皮瓣颜色、外观、质地,术后并发症情况,恢复工作及对治疗效果满意度情况。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定拇指及示指功能。结果术后皮瓣均成活,手背供区创面均愈合。术后随访6~12个月,患者手背供区创面仅遗留线性瘢痕,皮瓣颜色与周围正常皮肤相似、外观饱满、质地柔软,无瘢痕触痛或瘢痕挛缩等并发症。患者拇指及示指感觉正常,均恢复正常工作,且对治疗效果表示满意。末次随访时,拇指及示指功能评定为优者9例、良者5例。结论采用第2掌背动脉穿支皮瓣接力示指背侧岛状皮瓣修复拇指创面,不损伤主要血管,术后手背供区创面仅遗留线性瘢痕,皮瓣外观及示指、拇指功能较好,手术操作相对简单,具有较佳的临床效果。
- 穿支皮瓣 /
- 外科皮瓣 /
- 拇指 /
- 指损伤 /
- 显微外科手术 /
- 创面修复 /
- 第2掌背动脉
Abstract: Objective To explore the effects of the second dorsal metacarpal artery perforator flap relaying the dorsal island flap of index finger in repairing thumb wounds. Methods The study was a retrospective observational study. From May 2021 to January 2023, 14 patients with thumb wounds who met the inclusion criteria were admitted to Gansu Provincial People's Hospital, including 8 males and 6 females, aged 24 to 63 years. After debridement, the wound area was 2.1 cm×1.2 cm to 5.5 cm×3.5 cm. The dorsal island flap of index finger with incision area of 2.4 cm×1.5 cm to 5.5 cm×3.5 cm was used to repair the thumb wound, and then the second dorsal metacarpal artery perforator flap with incision area of 2.7 cm×1.6 cm to 5.7 cm×3.6 cm was cut through the same incision to repair the donor wound in the index finger, and the donor wound in the dorsal of hand was directly sutured. The survival of flap was observed, and the healing of the donor wound in the dorsal of hand was observed after operation. The condition of donor wound in the dorsal of hand, the color, appearance, and texture of flap, postoperative complications, return to work, and satisfaction with the treatment effect of patients were followed up. At the last follow-up, the function of the thumb and the index finger was evaluated with the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association. Results After operation, all flaps survived, and the donor wounds on the back of the hands healed. During follow-up of 6-12 months, only linear scars remained on the donor wounds in the dorsal of hands, and the color of flaps was similar to that of the surrounding normal skin, with a full appearance and soft texture. There were no complications such as scar tenderness or scar contracture in any patient. All patients had normal sensation in the thumb and index finger, resumed normal work, and were satisfied with the treatment effects. At the last follow-up, the function of thumb and index finger was evaluated as excellent in 9 cases and good in 5 cases. Conclusions The second dorsal metacarpal artery perforator flap can repair the thumb wound by relaying the dorsal island flap of index finger, without damaging the major blood vessels, with only linear scars remained on the donor wounds in the dorsal of hands after operation, with good appearance of flap and function of thumb and index finger. The operation is relatively simple with good clinical effects.
- Perforator flap /
- Surgical flaps /
- Thumb /
- Finger injuries /
- Microsurgery /
- Wound repair /
- The second dorsal metacarpal artery
陈艳：数据整理、论文撰写与修改、手术实施；谢斌、刘远俊：术后随访、数据收集；吴健：研究指导、经费支持、手术实施

所有作者均声明不存在利益冲突

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参考文献(35)

[1]	李光早, 徐静, 胡鸿泰, 等. 指背血管蒂岛状皮瓣修复拇指组织缺损[J]. 中华显微外科杂志, 2005, 28(3): 205-207,插图3-2. DOI: 10.3760/cma.j.issn.1001-2036.2005.03.006.
[2]	ZhangX, ShaoXZ, RenCZ, et al. Use of the second dorsal metacarpal artery-based bilobed island flap for thumb reconstruction[J]. J Reconstr Microsurg, 2012,28(2):125-132. DOI: 10.1055/s-0031-1289164.
[3]	张文龙,王增涛,高顺红,等. 第二掌背动脉终末支双“n”形皮瓣修复拇指末节脱套伤[J]. 中华显微外科杂志, 2013,36(1):65-67. DOI: 10.3760/cma.j.issn.1001-2036.2013.01.019.
[4]	王增涛, 朱磊, 李常辉. T形掌背动脉皮支皮瓣逆行转移修复手指环形软组织缺损[J].中华显微外科杂志,2008,31(1):12-14,插图1-1. DOI: 10.3760/cma.j.issn.1001-2036.2008.01.006.
[5]	王自方, 明立功, 李洋洋. 第2掌背动脉皮支皮瓣接力修复示指和中指供区创面[J].中华显微外科杂志,2019,42(5):490-493. DOI: 10.3760/cma.j.issn.1001-2036.2019.05.018.
[6]	JaquetY, EnepekidesDJ, TorgersonC, et al. Radial forearm free flap donor site morbidity: ulnar-based transposition flap vs split-thickness skin graft[J]. Arch Otolaryngol Head Neck Surg, 2012,138(1):38-43. DOI: 10.1001/archoto.2011.216.
[7]	ChangSC, ChenSL, ChenTM, et al. Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb[J]. Ann Plast Surg, 2004,53(5):449-454. DOI: 10.1097/01.sap.0000137134.15728.dd.
[8]	ZhangW, LiuL, LuY, et al. Reconstruction of thumb defects using the second dorsal metacarpal artery flap with two pivot points[J]. Plast Reconstr Surg, 2023, 152(6): 1063e-1071e. DOI: 10.1097/PRS.0000000000010514.
[9]	张文龙, 赵刚, 高顺红, 等. 第2掌背动脉皮支皮瓣的解剖与临床应用[J].中华整形外科杂志,2016,32(2):118-122. DOI: 10.3760/cma.j.issn.1009-4598.2016.02.009.
[10]	LiuP, DengZY, ZhangT, et al. Anatomical characteristics of cutaneous branches extending from the second dorsal metacarpal artery[J]. Front Bioeng Biotechnol, 2020,8:995. DOI: 10.3389/fbioe.2020.00995.
[11]	王洋洋, 邵牧, 巨积辉, 等. 应用第2掌背动脉穿支皮瓣急诊修复示指指背软组织缺损[J] . 中华显微外科杂志,2020,43(1): 71-73. DOI: 10.3760/cma.j.issn.1001-2036.2020.01.018.
[12]	潘达德, 顾玉东, 侍德,等. 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, 16(3):130-135.DOI: 10.3760/cma.j.issn.1005-054X.2000.03.003.
[13]	ZhuHW, ZhangX, YanMY, et al. Treatment of complex soft-tissue defects at the metacarpophalangeal joint of the thumb using the bilobed second dorsal metacarpal artery-based island flap[J]. Plast Reconstr Surg, 2013,131(5):1091-1097. DOI: 10.1097/PRS.0b013e3182865c26.
[14]	邓呈亮,魏在荣,孙广峰,等. 接力逆行穿支皮瓣修复手指远端及供瓣区皮肤软组织缺损[J]. 中华烧伤杂志,2015,31(2):107-111.DOI: 10.3760/cma.j.issn.1009-2587.2015.02.008.
[15]	李德保, 张治家, 王志勇, 等. 携带感觉神经的示指背皮瓣在拇指皮肤软组织缺损修复中的应用研究[J].中国美容医学,2019,28(7):56-57.
[16]	WangX, LvJD, LiuSJ, et al. Effect of dorsal nerve fascial island flap on repairing distal soft tissue defects at the proximal segment of the index, middle, ring, and little fingers[J]. J Orthop Surg Res, 2022,17(1):413. DOI: 10.1186/s13018-022-03309-9.
[17]	YuGR, YuanF, ChangSM, et al. Microsurgical second dorsal metacarpal artery cutaneous and tenocutaneous flap for distal finger reconstruction: anatomic study and clinical application[J]. Microsurgery, 2005,25(1):30-35. DOI: 10.1002/micr.20077.
[18]	YangD, MorrisSF. Reversed dorsal digital and metacarpal island flaps supplied by the dorsal cutaneous branches of the palmar digital artery[J]. Ann Plast Surg, 2001,46(4):444-449. DOI: 10.1097/00000637-200104000-00017.
[19]	SebastinSJ, MendozaRT, ChongAKS, et al. Application of the dorsal metacarpal artery perforator flap for resurfacing soft-tissue defects proximal to the fingertip[J]. Plast Reconstr Surg, 2011,128(3):166e-178e. DOI: 10.1097/PRS.0b013e318221ddfa.
[20]	MaYM , MengXJ , SuY ,et al. Bipedicle advancement flap for skin coverage after digital mucous cyst excision: a retrospective study of 18 cases[J]. Orthop Surg, 2021,13(1):196-201. DOI: 10.1111/os.12869.
[21]	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.
[22]	周健,魏在荣,黄广涛,等. 改良掌背动脉皮支筋膜蒂皮瓣修复手指近节与中节创面的临床效果[J]. 中华烧伤杂志,2020,36(8):734-737. DOI: 10.3760/cma.j.cn501120-20200212-00055.
[23]	LinYT, LohCYY, LinCH. Flaps based on perforators of the digital artery[J]. Hand Clin, 2020, 36(1): 57-62. DOI: 10.1016/j.hcl.2019.08.007.
[24]	薛继东,狄海萍,梁琰,等. 足部微型皮瓣游离移植修复手指Ⅳ度电烧伤创面的疗效[J]. 中华烧伤与创面修复杂志,2023,39(8):724-730. DOI: 10.3760/cma.j.cn501225-20230323-00094.
[25]	ZhangX, HeYJ, ShaoXZ, et al. Second dorsal metacarpal artery flap from the dorsum of the middle finger for coverage of volar thumb defect[J]. J Hand Surg Am, 2009,34(8):1467-1473. DOI: 10.1016/j.jhsa.2009.04.040.
[26]	于春波, 刘鹏, 梁亚闯, 等. 第2掌背动脉-指背动脉蒂双叶微皮瓣的应用解剖[J].中华显微外科杂志,2019,42(6):562-565. DOI: 10.3760/cma.j.issn.1001-2036.2019.06.011.
[27]	YangHY, ZhangJF, HuoYX, et al. Second dorsal metacarpal artery-based index finger dorsal island flap for the management of thumb defects[J]. J Plast Reconstr Aesthet Surg, 2022,75(1):325-331. DOI: 10.1016/j.bjps.2021.08.016.
[28]	杨焕友, 王斌, 李瑞国, 等. 第2掌背动脉供血的示指近节背侧岛状皮瓣修复拇指软组织缺损[J].中华显微外科杂志,2021,44(3):276-278. DOI: 10.3760/cma.j.cn441206-20190327-00135.
[29]	邵汝谊, 卢焕兴, 章银灿. 示指背侧岛状皮瓣在拇指指端缺损中的应用[J].中华显微外科杂志,2006,29(5):393-394. DOI: 10.3760/cma.j.issn.1001-2036.2006.05.033.
[30]	ItoO, IgawaHH, SuzukiS, et al. Evaluation of the donor site in patients who underwent reconstruction with a free radial forearm flap[J]. J Reconstr Microsurg, 2005,21(2):113-117. DOI: 10.1055/s-2005-864844.
[31]	ChiZL, LinDM, ChenYH, et al. Routine closure of the donor site with a second dorsal metacarpal artery flap to avoid the use of a skin graft after harvest of a first dorsal metacarpal artery flap[J]. J Plast Reconstr Aesthet Surg, 2018,71(6):870-875. DOI: 10.1016/j.bjps.2018.01.031.
[32]	池征璘, 陈一衡, 罗鹏, 等. 改良示指背侧岛状皮瓣修复拇指指端软组织缺损[J].中华显微外科杂志,2019,42(3):228-231. DOI: 10.3760/cma.j.issn.1001-2036.2019.03.005.
[33]	吴国良,李学渊,陈宏. 游离皮瓣修复指尖缺损的治疗进展[J]. 中华显微外科杂志,2024,47(3):350-355.DOI: 10.3760/cma.j.cn441206-20231109-00072.
[34]	CaiLY, ZhangX, ZhangYY, et al. Reconstruction of composite soft tissue defect in the distal finger using partial toenail flap transfer[J]. Orthop Surg, 2023,15(10):2716-2723. DOI: 10.1111/os.13829.
[35]	吴学强, 刘会仁, 王岩, 等. 第2掌背动脉游离皮瓣的解剖及临床应用[J].中华显微外科杂志,2023,46(4):442-446. DOI: 10.3760/cma.j.cn441206-20221116-00232.

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图 1 第2掌背动脉穿支皮瓣与示指背侧岛状皮瓣设计

注：手背上的粗线为第2掌背动脉穿支皮瓣与示指背侧岛状皮瓣切口设计线,虚线为第2掌背动脉穿支皮瓣设计线

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图 2 采用第2掌背动脉穿支皮瓣接力示指背侧岛状皮瓣修复例1患者左手拇指电烧伤创面的效果。2A.术前左手拇指创面被坏死组织覆盖,创面深达骨表面；2B.术前设计示指背侧岛状皮瓣及第2掌背动脉穿支皮瓣；2C.术中切取示指背侧岛状皮瓣及第2掌背动脉穿支皮瓣；2D.术中将示指背侧岛状皮瓣经过皮下隧道转移覆盖拇指创面即刻；2E.术中将第2掌背动脉穿支皮瓣覆盖示指供区创面,手背供区创面直接缝合后即刻；2F.术后1年,示指和拇指伸直情况,手背仅遗留线性瘢痕；2G.术后1年,皮瓣存活良好,皮瓣颜色与周围正常皮肤相似；2H.术后1年桡侧拇指和示指屈曲活动情况,手指关节活动度均良好；2I.术后1年掌背侧示指屈曲活动情况,手指关节活动度良好

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图 3 采用第2掌背动脉穿支皮瓣接力示指背侧岛状皮瓣修复例2患者瘢痕挛缩畸形所致右手拇指创面的效果。3A.术前右手拇指因瘢痕牵拉向桡侧挛缩,指间关节脱位；3B.术前设计示指背侧岛状皮瓣及第2掌背动脉穿支皮瓣；3C.术中切取示指背侧岛状皮瓣及第2掌背动脉穿支皮瓣；3D.术中切取第2掌背动脉穿支皮瓣后即刻；3E.术中将示指背侧岛状皮瓣经过皮下隧道转移覆盖拇指创面即刻；3F.术中将第2掌背动脉穿支皮瓣覆盖示指供区创面,手背供区创面直接拉拢缝合即刻；3G.术后6个月掌背侧示指和拇指伸直情况,示指皮瓣存活良好,手背仅遗留线性瘢痕；3H.术后6个月桡侧示指和拇指伸直情况,拇指皮瓣存活良好；3I.术后6个月,示指屈曲功能正常

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