前臂逆行穿支皮瓣在修复手背软组织缺损中的应用

目的研究前臂逆行穿支皮瓣在修复手背创面中的应用。方法 2014年7月—2016年9月任丘市人民医院骨二科对33例手背皮肤缺损患者采用前臂逆行穿支皮瓣进行修复,根据缺损的部位,应用骨间后动脉穿支皮瓣修复17例,尺动脉腕背支前臂穿支皮瓣修复16例。通过评估术后患者移植皮瓣生长优良率来判断临床效果。所有患者均随访6~18个月,平均随访1年。结果骨间后动脉穿支皮瓣及尺动脉腕背支前臂穿支皮瓣各有1例坏死,二期行腹部带蒂皮瓣修复创面。2例患者出现皮瓣远端部分坏死,1例经换药后愈合,另1例经换药肉芽组织新鲜后行游离植皮后愈合;其余29例皮瓣全部成活。骨间后动脉组皮瓣总优良率为94.1%,尺动脉腕上皮支组总优良率为93.8%(P0.05)。术后1、6个月及1年对患者进行随访,末次随访时皮瓣外观无明显臃肿,色泽与周边组织接近,质地良好。供区创面部分闭合后行全厚皮片游离植皮,成活良好。结论采用前臂骨间后动脉穿支皮瓣及尺动脉腕背支前臂穿支皮瓣修复手背皮肤缺损不损伤主干血管,血管相对恒定,血供较可靠,供受区一个术野完成手术,手术方法相对简单、安全,适合在基层医院开展。

Forearm reverse island flap for repairing soft tissue defect of hand

Objective To study the application of forearm reverse island flap in the repair of soft tissue de-fects at the dorsum of hand.Methods A total of 33 patients with soft tissue defects at the dorsum of hand were enrolled in Renqiu People's Hospital from Jul.2014 to Sep.2016,who were treated using retrograde forearm island flap.According to the defect site ,antebrachial dorsal interosseous artery retrograde island flap was performed in 17 cases,and 16 cases were conducted with retrograde ulnar dorsal flap.The excellent rate of postoperative graft flap growth was used to evaluate the clinical effect.All patients were followed up for 6-18 months and the mean follow -up time was 1 year.Results Two patients presented necrosis in posterior interosseous artery perforation flap and the ulnar artery carpal dorsal forearm perforated flap respectively ,then in the second stage the abdominal pedicled flap was executed to repair the wound.Two patients had partial necrosis of the distal part of the skin flap ,one of them had recovered after dressing ,the other one turned for the better due to free skin grafting after free granulation tissue grew.The remaining 29 cases all survived.The excellent rate of postoperative graft flap growth in the group of interosseous artery was 94.1%,and in the group of retrograde ulnar dorsal flap was 93.8%( P＞0.05).The pa-tients were followed up at 1,6 months and 1 year,and the skin flap was not significantly swollen and the color was close to the surrounding tissue at the end of the follow-up.After the supply area was closed ,free skin graft of whole thick skin was conducted and the skin survived well.Conclusion Forearm interosseous artery flap and retrograde ulnar dorsal flap to repair the soft tissue defects at the dorsum of hand does not damage the main blood vessels and nerves,furthermore the blood vessels are constant and the blood supply is reliable.The operation of the donor area and the receiving area are completed in one surgical field.In addition,the procedure is simple and safe to be applied in basic hospitals.