臂外侧游离组织瓣修复手指复杂创面的疗效

杨曦; 刘武华; 段家章; 方翔; 徐永清; 石岩; 张兴; 何晓清

doi:10.3760/cma.j.cn501225-20240927-00359

臂外侧游离组织瓣修复手指复杂创面的疗效

doi: 10.3760/cma.j.cn501225-20240927-00359

杨曦¹,
刘武华²,
段家章²,
方翔¹,
徐永清¹,
石岩¹,
张兴³,
何晓清^1, ,

1.
解放军联勤保障部队第九二〇医院骨科,昆明　650032
2.
云南省第二人民医院手足外科,昆明　650021
3.
平顶山市湛河骨伤科医院创伤骨科,平顶山　462500

基金项目:

云南省科技厅科技计划临床中心建设项目 202102AA310068

云南省科技厅科技计划科技人才与平台计划项目 202405AD350024

联勤保障部队第九二〇医院院内科技计划面上项目 2023YGY15

详细信息

通讯作者:
何晓清,Email：6292753@qq.com

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出版历程
- 收稿日期: 2024-09-27
- 网络出版日期: 2025-11-27

Efficacy of free lateral arm tissue flap in repairing complex finger wounds

1.
Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of PLA, Kunming 650032, China
2.
Department of Hand and Foot Surgery, the Second People's Hospital of Yunnan Province, Kunming 650021, China
3.
Department of Traumatic Orthopedics, Pingdingshan Zhanhe Orthopedics Hospital, Pingdingshan 462500, China

Funds:

Clinical Center Construction Project of the Science and Technology Plan of Department of Science and Technology of Yunnan Province 202102AA310068

Science and Technology Talent and Platform Program Project under the Science and Technology Plan of Department of Science and Technology of Yunnan Province 202405AD350024

General Program of In-hospital Science and Technology Plan of the 920th Hospital of Joint Logistic Support Force of PLA 2023YGY15

More Information

Corresponding author: He Xiaoqing, Email: 6292753@qq.com

摘要

摘要: 目的探讨臂外侧游离组织瓣修复手指复杂创面的疗效。方法该研究为回顾性观察性研究。2020年1月—2023年12月,解放军联勤保障部队第九二〇医院收治8例符合入选标准的手指复杂创面患者,其中男5例、女3例,年龄24~56岁。多指皮肤缺损者4例；单指皮肤及骨复合缺损者4例,其中3例合并伸指肌腱缺损。皮肤缺损大小为2.5 cm×2.0 cm~8.0 cm×3.5 cm,骨缺损大小为1.5 cm×1.0 cm×1.0 cm~2.0 cm×1.5 cm×1.0 cm。急诊清创同期行臂外侧游离组织瓣移植修复者5例；其余3例患者Ⅰ期行扩大清创,Ⅱ期行臂外侧游离组织瓣移植修复。各有4例患者切取分叶皮瓣与嵌合骨皮瓣,其中携带臂后侧皮神经者4例,用肱三头肌腱膜重建伸指肌腱者3例,皮瓣大小为3.0 cm×2.5 cm~9.0 cm×4.0 cm,骨瓣大小与骨缺损大小一致。将皮瓣及骨瓣供区创面间断缝合。观察术后组织瓣存活情况,记录分叶皮瓣断蒂情况。观察并记录末次随访时皮瓣外观、质地,采用英国医学研究委员会感觉功能评定标准评价的移植臂后侧皮神经的患指感觉恢复情况,移植肱三头肌腱膜的患指背伸情况,X线检查确认的骨瓣成活情况,皮瓣供区瘢痕形成情况,采用中华医学会手外科学会上肢部分功能评定试用标准评定的患指功能。结果术后,组织瓣均存活良好。分叶皮瓣均在术后4周局部麻醉下成功断蒂。随访时间10~24个月,平均13.5个月。末次随访时,皮瓣颜色、质地良好,移植臂后侧皮神经的患指感觉恢复至S2~S3级,移植肱三头肌腱膜的患指背伸均获得有限改善,X线检查提示骨瓣成活,皮瓣供区创面愈合后形成线性瘢痕,患指功能评定为优者5例、良者3例。结论臂外侧组织穿支丰富且解剖变异少,可制备为分叶皮瓣及嵌合骨皮瓣用于手指复杂创面的修复,手术操作相对简单,术后供受区外观和功能较佳。
- 指 /
- 创伤和损伤 /
- 外科皮瓣 /
- 显微外科手术 /
- 臂外侧 /
- 分叶皮瓣 /
- 嵌合骨皮瓣 /
- 创面修复
Abstract: Objective To explore the efficacy of free lateral arm flap in repairing complex finger wounds. Methods This study was a retrospective observational study. From January 2020 to December 2023, 8 patients with complex finger wounds who met the inclusion criteria were admitted to the 920^th Hospital of Joint Logistic Support Force of PLA, including 5 males and 3 females, aged 24 to 56 years. There were 4 cases with multi-finger skin defects; there were 4 cases with single-finger skin combined with bone defects, 3 of whom were complicated with extensor tendon defects. The size of skin defects was 2.5 cm×2.0 cm to 8.0 cm×3.5 cm, and the size of bone defects was 1.5 cm×1.0 cm×1.0 cm to 2.0 cm×1.5 cm×1.0 cm. Five cases were repaired by free lateral arm tissue flap transplantation in the same period of emergency debridement; the remaining 3 patients underwent extended debridement in stage Ⅰ and free lateral arm tissue flap transplantation for repair in stage Ⅱ. Four patients each underwent resection of lobulated flaps and chimeric osteocutaneous flaps, including 4 cases carrying the posterior arm cutaneous nerve and three cases had their extensor tendons being reconstructed with the triceps brachii aponeurosis. The size of skin flaps was 3.0 cm×2.5 cm to 9.0 cm×4.0 cm, and the size of bone flap was consistent with the size of the bone defect. The donor site wounds of skin flaps and bone flaps were closed with interrupted sutures. Postoperatively, the survival status of the tissue flaps was observed, and the pedicle division status of the lobulated flaps was recorded. At the final follow-up, the following parameters were assessed and documented: the appearance and texture of flaps, the sensory recovery of the affected finger transplanted with the posterior arm cutaneous nerve using the British Medical Research Council sensory function assessment criteria, the dorsiflexion of the affected finger transplanted with the triceps brachii aponeurosis, the survival of the bone flaps confirmed via X-ray examination, the scar formation at the donor sites of skin flaps, and the function of the affected fingers evaluated based on the trial standard for functional evaluation of the upper limb of the Hand Surgery Society of the Chinese Medical Association. Results Postoperatively, the tissue flaps survived well. The pedicles of the lobulated flaps were successfully divided under local anesthesia 4 weeks after surgery. The follow-up duration ranged from 10 to 24 months, with an average of 13.5 months. At the final follow-up, the color and texture of the flaps were good, the sensation of the affected fingers transplanted with posterior arm cutaneous nerve recovered to S2-S3 level, the affected fingers transplanted with triceps brachii aponeurosis all achieved limited improvement in dorsiflexion, X-ray examination showed that the bone flaps survived; linear scars formed at the donor sites of skin flaps after wound healing, and the function of the affected fingers was evaluated as excellent in 5 cases and good in 3 cases. Conclusions The lateral arm tissue is rich in perforators and has few anatomical variations, which can be prepared into lobulated flaps and chimeric osteocutaneous flaps for the repair of complex finger wounds. The surgical operation is relatively simple, and the appearance and function of the donor and recipient sites are relatively good after surgery.
- Fingers /
- Wounds and injuries /
- Surgical flaps /
- Microsurgery /
- Lateral arm /
- Lobulated flap /
- Chimeric osteocutaneous flap /
- Wound repair
杨曦、刘武华：手术操作、论文撰写；段家章、方翔、石岩：数据整理、统计学分析；徐永清：经费支持；张兴、何晓清：研究指导、论文修改

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下载: 全尺寸图片幻灯片

图 1 左臂外侧游离嵌合骨皮瓣切取标本解剖图。1A.血管蒂显露情况；1B.完全游离嵌合骨皮瓣后情况

注：蓝色箭头指示桡侧副动脉后支及臂后侧皮神经,白色箭头指示肱三头肌,红色箭头指示穿肱三头肌腱膜皮穿支,黑色箭头指示骨膜支及骨瓣,绿色箭头指示桡神经,黄色箭头指示桡动脉返支及其与桡侧副动脉的交通支

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图 2 采用左臂外侧游离分叶皮瓣修复例1患者左手中指与环指指腹缺损的效果。2A.入院时中指、环指指腹缺损情况；2B.皮瓣设计；2C.按设计切取皮瓣中；2D.皮瓣分叶后；2E.术后1周皮瓣成活,血管蒂覆盖的皮片存活良好；2F.术后1周患指可弯曲；2G、2H.分别为术后4周断蒂后侧面观、掌面观情况

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图 3 采用右臂外侧携带臂后侧皮神经的游离嵌合骨皮瓣修复例2患者右手拇指远节指骨及指背皮肤缺损的效果。3A.清创后,拇指远节皮肤及骨缺损情况；3B.皮瓣设计；3C.术中血管蒂显露；3D.切取的含臂后侧皮神经（血管钳处）的嵌合骨皮瓣；3E.术后1个月嵌合骨皮瓣成活后外观；3F.术后12个月,X线片显示移植骨瓣成活

注：蓝色三角示皮支和骨膜支,其中最远端三角指示骨膜支

下载: 全尺寸图片幻灯片