目的 报道应用尺动脉腕上穿支下行支flow-through皮瓣修复手指指腹软组织缺损伴指固有动脉缺损的临床效果。 方法 自2017年1月至2018年2月，收治6例手指指腹皮肤软组织缺损伴指固有动脉、神经缺损患者。创面面积（清创后面积）为2.0 cm×1.0 cm~3.5 cm×2.4 cm，动脉缺损0.8~2.2 cm，神经缺损0.8~2.7 cm。急诊采用尺动脉腕上穿支下行支flow-through皮瓣修复创面，切取皮瓣面积为2.3 cm×1.2 cm~4.3 cm×2.8 cm。 结果 6例手指及皮瓣完全成活。5例患者获随访8~24个月。末次随访时，皮瓣外观满意，质地柔软，稍臃肿，弹性佳。手指感觉恢复S2~S3+，两点辨别觉5~11 mm。根据中华医学会手外科学会上肢部分功能评定试用标准评定：优3指，良2指，功能恢复满意。所有患者供区仅可见一线形瘢痕，腕关节屈伸活动、肌力及感觉均正常。 结论 尺动脉腕上穿支下行支flow-through皮瓣可用于修复伴有指固有动脉缺损的手指软组织缺损，能较好地重建手指血运，恢复感觉。
Abstract
Objective To report the clinical efficacy of flow-through flap based on the descending branch of supracarpal cutaneous branch of ulnar artery for repairing the soft tissue defect of finger pulp with digital proper artery defect. Methods From January 2017 to February 2018, 6 patients with skin and soft-tissue defects of finger pulp with digital proper artery and nerve defects were repaired with flow-through flap based on the descending branch of supracarpal cutaneous branch of ulnar artery. The wound area ranged from 2.0 cm×1.0 cm to 3.5 cm×2.4 cm. The length of arterial defect ranged from 0.8 cm to 2.2 cm. The length of nerve defect ranged from 0.8 cm to 2.7 cm. The flap size ranged from 2.3 cm×1.2 cm to 4.3 cm×2.8 cm. Results All flaps survived completely. There were 5 cases followed up for 8~24 months. At the last follow-up, the flaps were satisfactory in appearance with slight bulkiness, soft in texture, and good in elasticity. The flap sensation recovered from S2 to S3+. The two-point discrimination was 5~11 mm. According to the evaluation criteria of upper limb function of hand surgery society of Chinese medical association, the function was excellent in 3 fingers, good in 2 fingers, and the functional recovery were satisfactory. Only a linear scar was left on the donor site in all patients. The wrist flexion and extension, muscle strength and sensation were normal. Conclusions The flow-through flap based on the descending branch of supracarpal cutaneous branch of ulnar artery can be used to repair the soft tissue defect of finger with digital proper artery defect. It can reconstruct the blood flow and sensation of finger.
关键词
尺动脉腕上穿支 /
flow-through皮瓣 /
外科皮瓣 /
软组织缺损 /
手指
Key words
Supracarpal cutaneous branch of ulnar artery /
Flow-through flap /
Surgical flaps /
Soft tissue defect /
Finger
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