高频彩色多普勒超声引导下精准设计第1掌骨桡背侧皮瓣修复拇指小面积皮肤软组织缺损的疗效

符健松; 刘英; 王辉; 高顺红; 马铁鹏; 董惠双; 于俊; 姚军; 周彤

doi:10.3760/cma.j.cn501225-20241130-00468

高频彩色多普勒超声引导下精准设计第1掌骨桡背侧皮瓣修复拇指小面积皮肤软组织缺损的疗效

doi: 10.3760/cma.j.cn501225-20241130-00468

符健松¹,
刘英²,
王辉¹,
高顺红¹,
马铁鹏¹,
董惠双¹,
于俊¹,
姚军¹,
周彤^1, ,

1.
唐山市第二医院手外科,唐山　　063000
2.
唐山市第二医院超声科,唐山　　063000

基金项目:

河北省医学科学研究课题 20240654

详细信息

通讯作者:
周彤,Email：13832978523@163.com

计量
- 文章访问数: 92
- HTML全文浏览量: 34
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2024-11-30

Efficacy of precisely designed first dorsal metacarpal artery flap under the guidance of high-frequency color Doppler ultrasound in repairing small-sized skin and soft tissue defects in the thumb

1.
Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China
2.
Department of Ultrasound, the Second Hospital of Tangshan, Tangshan 063000, China

Funds:

Medical Science Research Plan Project of Hebei Province of China 20240654

More Information

Corresponding author: Zhou Tong, Email: 13832978523@163.com

摘要

摘要: 目的探讨高频彩色多普勒超声引导下精准设计第1掌骨桡背侧皮瓣修复拇指小面积皮肤软组织缺损的疗效。方法该研究为回顾性观察性研究。2021年1月—2023年8月,唐山市第二医院手外科收治29例符合入选标准的拇指小面积皮肤软组织缺损患者,其中男16例、女13例,年龄22~65岁,清创后创面面积为2.5 cm×1.5 cm~3.0 cm×2.0 cm。皮瓣移植术前均记录高频彩色多普勒超声检查测得的患指第1掌骨桡背侧动脉与桡侧指固有动脉吻合支的体表投影,术中切取第1掌骨桡背侧皮瓣修复拇指缺损,皮瓣切取面积为3.0 cm×2.0 cm~3.5 cm×2.5 cm。将皮瓣携带的桡神经浅支分支与受区指固有神经吻合,将皮瓣供区创面直接缝合。观察术前高频彩色多普勒超声检查测得的患指第1掌骨桡背侧动脉与桡侧指固有动脉吻合支的体表投影与术中探查情况是否一致。术后观察供受区创面愈合情况和拆线时间、皮瓣成活情况。术后6~12个月末次随访时,按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患指功能,并计算优良率；行皮瓣疗效满意度评分；另测定皮瓣两点辨别觉距离和行Semmes-Weinstein单纤维检查评估皮瓣感觉功能。结果 29例患者术前高频彩色多普勒超声检查测得的患指第1掌骨桡背侧动脉与桡侧指固有动脉吻合支的体表投影与术中探查情况均一致。术后,所有供受区创面均愈合良好,拆线时间为术后14~16 d；26例患者皮瓣全部成活,3例患者皮瓣部分坏死。末次随访时,患指功能评分为（88±8）分,优良率为96.6%（28/29）；皮瓣疗效满意度评分为（7.4±1.0）分；皮瓣两点辨别觉距离为（6.9±0.7）mm,Semmes-Weinstein单纤维检查结果为（3.46±0.19）g。结论应用高频彩色多普勒超声引导精准设计第1掌骨桡背侧皮瓣修复拇指小面积皮肤软组织缺损,具有皮瓣成活率高、患指功能恢复好、皮瓣疗效满意度高等优点。
- 外科皮瓣 /
- 穿支皮瓣 /
- 显微外科手术 /
- 超声检查,多普勒,彩色 /
- 第1掌骨桡背侧动脉 /
- 皮肤软组织缺损 /
- 创面修复
Abstract: Objective To explore the efficacy of precisely designed first dorsal metacarpal artery flap under the guidance of high-frequency color Doppler ultrasound in repairing small-sized skin and soft tissue defects in the thumb. Methods This study was a retrospective observational study. From January 2021 to August 2023, 29 patients with small-sized skin and soft tissue defects in the thumb who met the inclusion criteria were admitted to the Department of Hand Surgery of the Second Hospital of Tangshan. There were 16 males and 13 females, with ages ranging from 22 to 65 years. The wound area after debridement ranged from 2.5 cm×1.5 cm to 3.0 cm×2.0 cm. Before flap transplantation, the body surface projections of the anastomotic branches between the first metacarpal radial dorsal artery and the radial proper digital artery of the affected finger measured by high-frequency color Doppler ultrasound examination were recorded. During surgery, the first dorsal metacarpal artery flap was harvested to repair the defects in the thumb, with the harvested flap area of 3.0 cm×2.0 cm to 3.5 cm×2.5 cm. The superficial branch of radial nerve carried by the flap was anastomosed with the proper digital nerve in the recipient area. The wound in the flap donor site was directly sutured. It was observed whether the body surface projections of the anastomotic branches between the first metacarpal radial dorsal artery and the radial proper digital artery of the affected finger measured by preoperative high-frequency color Doppler ultrasound examination were consistent with the intraoperative findings. After surgery, the wound healing and suture removal time in the donor and recipient sites, as well as the flap survival were observed. At the last follow-up (6-12 months postoperatively), the function of the affected finger was evaluated according to the trial criteria for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and the excellent and good rate was calculated. The satisfaction scoring of flap efficacy was performed. Additionally, the two-point discrimination distance of flap was measured, and Semmes-Weinstein monofilament test was performed to evaluate flap sensory function. Results The body surface projections of the anastomotic branches between the first metacarpal radial dorsal artery and the radial proper digital artery of the affected finger of 29 patients measured by preoperative high-frequency color Doppler ultrasound examination were all consistent with the intraoperative findings. After surgery, all wounds in the donor and recipient sites healed well, the suture removal time was 14-16 days postoperatively. The flaps survived completely in 26 patients, and the partial flap necrosis occurred in 3 patients. At the last follow-up, the functional score of the affected finger was 88±8, with the excellent and good rate of 96.6% (28/29). The satisfaction scoring of flap efficacy was 7.4±1.0, the two-point discrimination distance of flap was (6.9±0.7) mm, and the Semmes-Weinstein monofilament test result was (3.46±0.19) g. Conclusions The application of precisely designed first dorsal metacarpal artery flap under the guidance of high-frequency color Doppler ultrasound in repairing small-sized skin and soft tissue defects in the thumb has the advantages of high flap survival rate, good functional recovery of the affected finger, and high satisfaction with flap efficacy.
- Surgical flaps /
- Perforator flap /
- Microsurgery /
- Ultrasonography, Doppler, color /
- First metacarpal radial dorsal artery /
- Skin and soft tissue defects /
- Wound repair
符健松：实施手术、图片采集、文章撰写与修改、结果分析；刘英：手术设计与实施、结果分析、数据整理、图像采集；王辉、高顺红、马铁鹏：手术指导、结果分析、行政支持；董惠双、于俊、姚军：数据采集、图片采集、文献整理；周彤：手术设计与实施、结果分析、数据整理、图像采集、文章撰写与修改

所有作者声明不存在利益冲突

HTML全文

参考文献(40)

[1]	BacosJT, SasorSE. From simple to complex: preserving and reconstructing the traumatized thumb[J]. Clin Plast Surg,2024,51(4):559-573.DOI: 10.1016/j.cps.2024.04.001.
[2]	UsamiS, SonokiK, InamiK, et al. Application of extended ulnar parametacarpal perforator free flap for the reconstruction of total pulp defect of the thumb: a case report[J]. Microsurgery,2024,44(4):e31180. DOI: 10.1002/micr.31180.
[3]	WangH, YangX, ChenC, et al. Modified littler flap for sensory reconstruction of large thumb pulp defects[J]. J Hand Surg Eur Vol,2018,43(5):546-553.DOI: 10.1177/1753193417754191.
[4]	Braga SilvaJ,Vellinho BusnelloC,GrosA,et al.Analysis of thumb pulp reconstruction based on different local flaps: a systematic review[J].J Hand Microsurg,2024,16(4):100126.DOI: 10.1016/j.jham.2024.100126.
[5]	MerleM.A critical study of thumb reconstruction by second toe transfer[J].Ann Chir Main Memb Super,1991,10(6):517-522.DOI: 10.1016/s0753-9053(05)80322-9.
[6]	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.
[7]	张浩,张晓东,庾东春,等.应用带蒂皮瓣修复皮肤软组织缺损[J].中华骨科杂志,2012,32(3):260-264.DOI: 10.3760/cma.j.issn.0253-2352.2012.03.013.
[8]	李有斌,丁治红,姜涛,等.游离桡动脉掌浅支腕横纹皮瓣修复手指软组织缺损17例[J].中华显微外科杂志,2023,46(4):403-407.DOI: 10.3760/cma.j.cn441206-20230419-00069.
[9]	范筱,刘金海,劳克诚.以𧿹横动脉-跖腹静脉为蒂的微型𧿹甲皮瓣修复指腹甲床部分联合缺损[J].中华手外科杂志,2023,39(5):463-466.DOI: 10.3760/cma.j.cn311653-20221121-00302.
[10]	李一,李学渊,俞淼,等.双层人工真皮移植与拇指桡背侧岛状皮瓣转移修复拇指末节缺损的疗效比较[J].中华手外科杂志,2023,39(4):289-293.DOI: 10.3760/cma.j.cn311653-20230313-00048.
[11]	AhangarP, AkbaribazmM, RahimiM, et al. A case series study in newrestorative surgery in thumb amputation: the adiposofaciocutaneous flap technique for distal thumb amputation replantation[J]. Trauma Case Rep,2024,52:101052.DOI: 10.1016/j.tcr.2024.101052.
[12]	JayachandiranAP, RajendranS, AnanthappanM, et al. "Flap-in-flap" technique: double V-Y flap in fingertip injury management[J]. Indian J Plast Surg,2024,57(5):364-371.DOI: 10.1055/s-0044-1787278.
[13]	刘刚义,谢瑞菊,苟军全,等.邻指皮瓣移植修复难以再植的拇指末节离断伤[J].中华显微外科杂志,2019,42(5):499-501.DOI: 10.3760/cma.j.issn.1001-2036.2019.05.021.
[14]	MulicaM, YasminM, CaiA, et al. Long-term outcome of digital defect reconstruction using cross-finger flaps[J]. Handchir Mikrochir Plast Chir,2024,56(6):448-453.DOI: 10.1055/a-2351-6697.
[15]	龙航,黄银浩,徐佳丽,等.携带神经的第一掌背动脉尺侧支皮瓣修复拇指软组织缺损[J].中华手外科杂志,2022,38(2):126-129.DOI: 10.3760/cma.j.cn311653-20210520-00166.
[16]	Wolf-MandrouxA, DetammaeckerR, De AlmeidaYK, et al. Pedicled flap from the first dorsal branch of the proper palmar digital artery of the fingers: an anatomy study[J]. Hand Surg Rehabil,2024,39(5):431-436.DOI: 10.1016/j.hansur.2020.03.008.
[17]	叶红禹,赵晓航,胡振业,等.桡动脉掌浅支穿支蒂接力大鱼际皮瓣修复拇指末节皮肤缺损[J].中华手外科杂志,2018,34(2):153-154.DOI: 10.3760/cma.j.issn.1005-054X.2018.02.029.
[18]	LimJX, ChungKC. VY advancement, thenar flap, and cross-finger flaps[J]. Hand Clin,2020,36(1):19-32.DOI: 10.1016/j.hcl.2019.08.003.
[19]	王延玲,常艳,李三亮,等.高频彩色多普勒超声辅助下拇指尺侧指背动脉逆行岛状皮瓣修复同指远端皮肤软组织缺损的方法与效果[J].中华烧伤杂志,2021,37(6):555-561.DOI: 10.3760/cma.j.cn501120-20210223-00063.
[20]	WangJ,ZhouX,QiangL,et al.Thumb fingertip injuries reconstruction using a dorsoulnar flap of the thumb combined with relay V-Y flaps for donor site repair[J].J Orthop Surg (Hong Kong),2022,30(2):23094990211025089.DOI: 10.1177/23094990211025089.
[21]	曹金林,卢烨锋,周军辉,等.游离腕横纹穿支皮瓣在修复手指皮肤软组织缺损中的应用[J].中华手外科杂志,2024,40(1):31-33.DOI: 10.3760/cma.j.cn311653-20230413-00076.
[22]	FaderaniR, MannA, KokkinosC, et al. The free thenar flap for thumb pulp reconstruction: a case report[J]. Microsurgery,2023,43(8):847-854.DOI: 10.1002/micr.31089.
[23]	MoschellaF,CordovaA,PirrelloR,et al.Anatomic basis for the dorsal radial flap of the thumb: clinical applications[J].Surg Radiol Anat,1996,18(3):179-181.DOI: 10.1007/BF02346124.
[24]	YangD,MorrisSF.Vascular basis of dorsal digital and metacarpal skin flaps[J].J Hand Surg Am,2001,26(1):142-146.DOI: 10.1053/jhsu.2001.20967.
[25]	王自方,明立功,明立阳,等.重建感觉的第1掌骨桡背侧动脉皮支链皮瓣修复拇指末节软组织缺损[J].中华显微外科杂志,2024,47(3):325-327.DOI: 10.3760/cma.j.cn441206-20231215-00105.
[26]	张航,刘亚平,唐林俊,等.第1掌骨背侧带神经动脉化静脉皮瓣治疗拇指和手指指腹缺损[J].中华显微外科杂志,2023,46(5):511-515.DOI: 10.3760/cma.j.cn441206-20230604-00097.
[27]	孙长胜,张玲玲,张辉,等. 第1掌骨桡背侧皮瓣游离移植修复手指软组织缺损12例[J]. 中华显微外科杂志,2025,48(4):432-436. DOI: 10.3760/cma.j.cn441206-20241231-00285.
[28]	何晓清,杨曦,段家章,等.基于CTA精准皮瓣外科的理念与初步实践[J]. 中华骨科杂志,2022,42(6):365-373.DOI: 10.3760/cma.j.cn121113-20211119-00669.
[29]	ThomasB,WarszawskiJ,FalknerF,et al.A comparative study of preoperative color-coded Duplex ultrasonography versus handheld audible Dopplers in ALT flap planning[J].Microsurgery,2020,40(5):561-567.DOI: 10.1002/micr.30599.
[30]	SunnysinhD, DandagiS, SikkerimathBC, et al. Analysis of variation in anatomy of lower limb vasculature and implications for free fibula flap by color Doppler imaging[J]. J Maxillofac Oral Surg,2022,21(2):320-325.DOI: 10.1007/s12663-020-01483-z.
[31]	张文桐,杨勇,李峰,等.基于彩色多普勒超声定位的分层削薄旋髂浅动脉穿支皮瓣的临床疗效[J].中华烧伤与创面修复杂志,2025,41(1):45-52.DOI: 10.3760/cma.j.cn501225-20240927-00358.
[32]	赵书明,刘娜,刘学亮,等.彩色多普勒超声辅助下超薄胸背动脉穿支皮瓣的切取方案及临床应用效果[J].中华烧伤与创面修复杂志,2024,40(3):281-288.DOI: 10.3760/cma.j.cn501225-20231012-00111.
[33]	范新宇,徐永清,徐龙江,等.高频彩超结合超声造影技术在穿支皮瓣术前设计及评估中的应用[J].中华显微外科杂志,2013,36(4):322-326.DOI: 10.3760/cma.j.issn.1001-2036.2013.06.003.
[34]	王石,董帅,曹阳,等.高选择性动脉吲哚菁绿造影在游离股前外侧皮瓣设计中的应用[J].中华烧伤与创面修复杂志,2024,40(10):948-954.DOI: 10.3760/cma.j.cn501225-20240513-00174.
[35]	王成德,王爱,孙继玲,等.三维CT血管造影辅助下游离腓动脉穿支皮瓣修复前足皮肤软组织缺损创面的临床效果[J].中华烧伤与创面修复杂志,2022,38(7):661-666.DOI: 10.3760/cma.j.cn501120-20210914-00317.
[36]	方军,赵光宗,李华壮,等.三维CT血管造影辅助游离腓肠内侧动脉穿支皮瓣修复足部创面的疗效[J].中华烧伤与创面修复杂志,2023,39(4):343-349.DOI: 10.3760/cma.j.cn501225-20220930-00430.
[37]	周飞亚,张弦,蔡乐益,等.精准定位的微型股前外侧穿支皮瓣修复手指中等面积皮肤软组织缺损的效果[J].中华烧伤与创面修复杂志,2024,40(2):165-171.DOI: 10.3760/cma.j.cn501225-20231030-00150.
[38]	DortchJ, ForteAJ, BolanC, et al. Preoperative analysis of venous anatomy before deep inferior epigastric perforator free-flap breast reconstruction using ferumoxytol-enhanced magnetic resonance angiography[J]. Ann Plast Surg,2023,90(4):343-348.DOI: 10.1097/SAP.0000000000001421.
[39]	ChimH, NicholsDS, ChopanM. Ultrasound for perforator mapping and flap design in the hand and upper extremity[J]. J Hand Surg Am,2023,48(6):595-601.DOI: 10.1016/j.jhsa.2022.12.003.
[40]	XiaoW, LiK, Kiu-Huen NgS, et al. A prospective comparative study of color Doppler ultrasound and infrared thermography in the detection of perforators for anterolateral thigh flaps[J]. Ann Plast Surg,2020,84(5S Suppl 3):S190-195.DOI: 10.1097/SAP.0000000000002369.

下载: 全尺寸图片幻灯片

图 1 在高频彩色多普勒超声引导下精准设计第1掌骨桡背侧皮瓣急诊修复例1患者拇指小面积皮肤软组织缺损的疗效。1A.术前行高频彩色多普勒超声检查测量患指第1掌骨桡背侧动脉与桡侧指固有动脉吻合支的体表投影,其中黄色箭头指示患指第1掌骨桡背侧动脉与桡侧指固有动脉吻合支、绿色箭头指示第1掌骨桡背侧动脉皮穿支、白色箭头指示第1掌骨桡背侧动脉；1B.术中清创后,左拇指创面情况；1C.术中设计第1掌骨桡背侧皮瓣；1D.术中显露第1掌骨桡背侧动脉；1E.术中探查到的患指第1掌骨桡背侧动脉与拇指桡侧指固有动脉吻合支（黄色箭头指示）,与术前高频彩色多普勒超声检查测得的体表投影一致；1F.术中受区创面闭合即刻；1G.术中供区创面闭合即刻；1H.术后8个月末次随访时,皮瓣存活良好、无臃肿（上图显示）,供区愈合良好、仅遗留线性瘢痕（下图显示）

下载: 全尺寸图片幻灯片

图 2 在高频彩色多普勒超声引导下精准设计第1掌骨桡背侧皮瓣择期修复例2患者拇指小面积皮肤软组织缺损的疗效。2A.术前行高频彩色多普勒超声检查测量患指第1掌骨桡背侧动脉与桡侧指固有动脉吻合支的体表投影,其中黄色箭头指示患指第1掌骨桡背侧动脉与桡侧指固有动脉吻合支、绿色箭头指示第1掌骨桡背侧动脉皮穿支、白色箭头指示第1掌骨桡背侧动脉；2B.术中清创后,右拇指创面情况；2C.术中设计第1掌骨桡背侧皮瓣；2D.术中显露第1掌骨桡背侧动脉；2E.术中探查到的患指第1掌骨桡背侧动脉与拇指桡侧指固有动脉吻合支（黄色箭头指示）,与术前高频彩色多普勒超声检查测得的体表投影一致；2F.术中将皮瓣携带的桡神经浅支分支与拇指桡侧指固有神经残端吻合；2G.术中闭合创面后即刻皮瓣情况,采用大腿刃厚皮片移植覆盖剩余创面；2H.术后10个月末次随访时,皮瓣存活良好、无臃肿（上图显示）,供区愈合良好、仅遗留线性瘢痕（下图显示）

下载: 全尺寸图片幻灯片