旋转点下移的骨间后动脉穿支皮瓣修复手背皮肤缺损的临床应用

doi:10.13418/j.issn.1001-165x.2026.3.14

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中国临床解剖学杂志 ›› 2026, Vol. 44 ›› Issue (3) : 338-342. DOI: 10.13418/j.issn.1001-165x.2026.3.14

临床研究

旋转点下移的骨间后动脉穿支皮瓣修复手背皮肤缺损的临床应用

黄程伟^1，2，霍永鑫²*，白卫飞²，符健松²，翟婧秀³，暴启颖³，高远³

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Clinical application of posterior interosseous artery perforator flap with distalized rotation point for repairing skin defects of the dorsum of hand reconstruction

Huang Chengwei^1，2, Huo Yongxin²*, Bai Weifei², Fu Jiansong², Zhai Jingxiu³, Bao Qiying³, Gao Yuan³

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摘要

目的探讨基于血管体区（Angiosome）与穿支体区（Perforasome）理论，改良低旋转点骨间后动脉（Posterior interosseous artery, PIOA）皮支血管链皮瓣的设计方法，评价其在修复手背、手指背侧及虎口区皮肤缺损中的解剖基础与临床效果。方法回顾性分析 2024 年 3 月至 2025 年 6 月收治的 9 例手部复杂皮肤软组织缺损患者。男 8 例，女 1 例；年龄 18~57 岁机器绞伤6例，砸伤3例，8例为手背缺损，1例为手掌尺侧缺损，合并骨折8例，单纯软组织缺损1例，创面面积2.5 cm×3.0 cm~6.0 cm×11.0 cm，均为创伤较重的手外伤急诊患者。创面2期修复，采用改良术式，以第 3、4 掌骨基底水平为旋转点，利用 PIOA 终端皮支与腕背动脉网穿支间的皮支链供血。切取层次位于深筋膜浅层，不分离血管主干，皮瓣切取范围结果3.0 cm×3.5 cm~6.5 cm×11.5 cm，供区直接缝合或全层皮片移植修复。结果 9 例皮瓣全部成活，创面均 I 期愈合。随访 5~12 个月（平均 8.5 个月），皮瓣质地、外观满意。手部功能评价DASH评分平均9.2分。手术未触及前臂近端骨间后神经（Posterior interosseous nerve, PIN）损伤“危险区”。结论改良低旋转点 PIOA皮支血管链皮瓣利用皮支链网状血供，下移旋转点有效解决了手远端修复瓶颈并规避骨间后神经损伤风险，是修复手部远端复杂皮肤软组织缺损的理想术式。

Abstract

Objective To investigate the design of a modified posterior interosseous artery (PIOA) perforator chain flap with a low rotation point based on the angiosome and perforasome theory, and to evaluate its anatomical basis and clinical efficacy in repairing skin defects of the dorsum of hand, dorsal fingers, and first web space. Methods A retrospective analysis was performed on 9 patients with complex soft tissue defects of the hand admitted between March 2024 and June 2025. There were 8 males and 1 female, aged 18-57 years. The causes of injury included machine crush injuries in 6 cases and blunt injuries in 3 cases. Defects were located on the dorsum of hand in 8 cases and on the ulnar side of the palm in 1 case. Fractures were combined in 8 cases, and isolated soft tissue defects in 1 case. All were severe acute hand trauma patients, with wound areas ranging from 2.5 cm×3.0 cm to 6.0 cm×11.0 cm. All wounds underwent secondary repair using the modified surgical technique. The rotation point was set at the level of the base of the 3rd and 4th metacarpals, and the flap was supplied by the perforator chain between the terminal cutaneous branches of the PIOA and the dorsal carpal arterial arch. Dissection was performed at the superficial layer of the deep fascia without isolating the main vascular trunk. The flap size ranged from 3.0 cm×3.5 cm to 6.5 cm×11.5 cm. The donor site was closed primarily or covered with full-thickness skin grafts. Results All 9 flaps survived completely, and all wounds achieved primary healing. The follow-up period was 5-12 months (mean 8.5 months). The texture and appearance of the flaps were satisfactory. The mean DASH score was 9.2. Suprafascial dissection ensured no injury to the PIN. Conclusions The modified low-rotation-point PIOA perforator chain flap utilizes the network blood supply of the perforator chain, and distalizing the rotation point effectively overcomes the reconstructive bottleneck for distal hand defects while avoiding the risk of posterior interosseous nerve injury, making it an ideal surgical method for repairing complex soft tissue defects of the distal hand.

导出引用

黄程伟, 霍永鑫, 白卫飞, 符健松, 翟婧秀, 暴启颖, 高远. 旋转点下移的骨间后动脉穿支皮瓣修复手背皮肤缺损的临床应用[J]. 中国临床解剖学杂志. 2026, 44(3): 338-342 https://doi.org/10.13418/j.issn.1001-165x.2026.3.14

Huang Chengwei, Huo Yongxin, Bai Weifei, Fu Jiansong, Zhai Jingxiu, Bao Qiying, Gao Yuan. Clinical application of posterior interosseous artery perforator flap with distalized rotation point for repairing skin defects of the dorsum of hand reconstruction [J]. Chinese Journal of Clinical Anatomy. 2026, 44(3): 338-342 https://doi.org/10.13418/j.issn.1001-165x.2026.3.14

中图分类号： R622.1 R322.71

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