Repair of skin and soft tissue defects at distal end of finger and donor site with relaying reversed perforator flaps
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摘要: 目的 探讨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的治疗效果。 方法 2011年6月–2013年6月,笔者单位收治手指远端皮肤软组织缺损患者17例共17指。采用带神经的指固有动脉穿支皮瓣逆行修复指端皮肤软组织缺损,掌背动脉穿支皮瓣逆行修复第1供瓣区,第2供瓣区给予拉拢缝合。手指创面面积为2.0 cm×1.5 cm~3.0 cm×2.0 cm,指固有动脉穿支皮瓣及掌背动脉穿支皮瓣的切取面积分别为2.2 cm×1.5 cm~3.6 cm×2.5 cm、2.5 cm×2.0 cm~4.2 cm×3.0 cm。 结果 术后34个皮瓣均顺利成活,1个皮瓣术后发生青紫,表皮坏死,经换药后创面愈合。患者均获随访,随访时间1~18个月,平均8个月。皮瓣色泽、质地良好。第1供瓣区无凹陷、破溃,第2供瓣区残留线性瘢痕,不影响整体外观。位于关节处或肌腱表面的供瓣区愈合后不影响关节以及肢体活动。手指总主动活动度法评定手功能:优15指、良2指。皮瓣感觉功能评定:S3级1指、S4级2指、S5级14指;皮瓣两点辨别觉距离达5~7 mm,平均为6 mm。 结论 接力逆行穿支皮瓣的血供可靠,手术部位均在手部,能修复手指远端皮肤软组织缺损,同时改善第1供瓣区外形和功能。Abstract: Objective To explore the clinical effects of relaying reversed perforator flaps in repairing skin and soft tissue defects at distal end of finger and donor site. Methods Seventeen patients (17 fingers) with skin and soft tissue defects at distal end of finger were hospitalized from June 2011 to June 2013. The reversed digital artery perforator flap with branch of digital nerve was used to repair the defect. The first donor site was repaired by dorsal metacarpal artery perforator flap; the second donor site was closed by suturing. The area of skin defect at distal end of finger ranged from 2.0 cm×1.5 cm to 3.0 cm×2.0 cm, and the area of digital artery perforator flap and dorsal metacarpal artery perforator flap ranged from 2.2 cm×1.5 cm to 3.6 cm×2.5 cm and 2.5 cm×2.0 cm to 4.2 cm×3.0 cm, respectively. Results All the 34 flaps survived completely. Cyanosis and partial necrosis of the epidermis appeared in 1 flap, which was healed after dressing change. All the patients were followed up for 1 to 18 months, with mean time of 8 months. The color, texture and appearance of flaps were satisfactory. There was no depression or breakdown in the first donor sites. Some linear scars appeared in the second donor sites, but they did not affect the general appearance. The donor sites at joint or tendon did not affect the joint activity after healing. The results of function evaluation of range of active movement of the fingers were excellent in 15 cases and good in 2 cases. The results of sensation of the flaps were S3 in 1 finger, S4 in 2 fingers, and S5 in 14 fingers. The distance of two-point discrimination of flaps ranged from 5 to 7 mm, with mean distance of 6 mm. Conclusions Relaying reversed perforator flap, with reliable blood supply and both donor sites in the hand, can improve the appearance and function of the first donor site as well as repair skin and soft tissue defects at distal end of finger.
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Key words:
- Surgical flaps /
- Reconstructive surgical procedures /
- Soft tissue injuries /
- Hand
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