腕部掌側橈動脈掌淺支橫行微型皮瓣游離移植修復手指皮膚缺損_《中國修復重建外科雜志》

作者：

趙民 ¹ , 田德虎 ² , 邵新中 ² , 李大村 ¹ , 劉井達 ¹ , 趙亮 ¹ , 李海雷 ¹ , 王曉磊 ¹ , 張文桐 ¹ , 李建鋒 ¹

1 中國醫科大學北京市順義醫院上肢外科（北京，101300）;;
2 河北醫科大學第三醫院手外科;

關鍵詞：

腕部掌側橫行微型皮瓣橈動脈掌淺支手指創面修復

DOI：

10.7507/1002-1892.20130324

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目的探討以橈動脈掌淺支為蒂的腕部掌側橫行微型皮瓣游離移植修復手指皮膚缺損的療效。方法2011年12月－2013年2月，收治手指皮膚缺損26例（26指）。男20例，女6例；年齡20～56歲，平均31.5歲。致傷原因：切割傷20例，擠壓傷6例。受傷至入院時間為1～5 h，平均2 h。損傷指別：拇指6例，示指6例，中指6例，環指4例，小指4例。損傷部位：指背側6例，指側方6例，指端掌側14例；手指近節4例，中節8例，末節14例。創面范圍為2.0 cm × 1.5 cm～4.0 cm × 2.0 cm。采用大小為2.5 cm × 2.0 cm～4.5 cm × 2.5 cm以橈動脈掌淺支為蒂的腕部掌側橫行微型皮瓣游離移植修復。供區直接拉攏縫合。結果術后1例皮瓣遠端部分壞死，經換藥治療后創面瘢痕愈合；余25例皮瓣全部成活，創面Ⅰ期愈合。供區切口均Ⅰ期愈合。26例均獲隨訪，隨訪時間6～12個月，平均10個月。皮瓣外形滿意，質地柔軟。術后6個月皮瓣兩點辨別覺為5～8 mm，平均6.8 mm。供區無瘢痕攣縮，腕關節屈、伸活動無明顯受限。結論以橈動脈掌淺支為蒂的腕部掌側橫行微型皮瓣游離移植修復手指皮膚缺損，具有供區隱蔽、皮瓣與手指皮膚相似度高、可攜帶神經及肌腱、手術在同一術野完成等優點。

引用本文： 趙民,田德虎,邵新中,李大村,劉井達,趙亮,李海雷,王曉磊,張文桐,李建鋒. 腕部掌側橈動脈掌淺支橫行微型皮瓣游離移植修復手指皮膚缺損. 中國修復重建外科雜志, 2013, 27(12): 1475-1479. doi: 10.7507/1002-1892.20130324 復制

1.	Jihui JU, Liu Y, Hou R. Ulnar artery distal cutaneous descending branch as free flap in hand reconstruction. Injury, 2009, 40(12): 1320-1326.
2.	Gao W, Yan H, Li Z, et al. The free dorsoradial forearm perforator flap: anatomical study and clinical application in finger reconstruction. Ann Plast Surg, 2011, 66(1): 53-58.
3.	Chen C, Tang P, Zhang X. Sensory reconstruction of a finger pulp defect using a dorsal homodigital island flap. Plast Reconstr Surg, 2012, 130(5): 1077-1086.
4.	Takeishi M, Shinoda A, Sugiyama A, et al. Innervated reverse dorsal digital island flap for fingertip reconstruction. J Hand Surg (Am), 2006, 31(7): 1094-1099.
5.	李學淵, 王曉峰, 滕曉峰, 等. 游離腓動脈肌皮穿支皮瓣修復手部皮膚缺損. 中華手外科雜志, 2007, 23(4): 214-215.
6.	Sakai S. Free flap from the flexor aspect of the wrist for resurfacing defects of the hand and fingers. Plast Reconstr Surg, 2003, 111(4): 1412-1420.
7.	趙民, 田德虎, 邵新中, 等. 腕部掌側橈動脈掌淺支橫行微型皮瓣的解剖學研究. 中國修復重建外科雜志, 2013, 27(7): 864-868.
8.	Yang JW, Kim JS, Lee DC, et al. The radial artery superficial palmar branch flap: a modified free thenar flap with constant innervation. J Reconstr Microsurg, 2010, 26(8): 529-538.
9.	Sassu P, Lin CH, Lin YT, et al. Fourteen cases of free thenar flap: a rare indication in digital reconstruction. Ann Plast Surg, 2008, 60(3): 260-266.
10.	Kim KS, Kim ES, Hwang JH, et al. Thumb reconstruction using the radial midpalmar (perforator-based) island flap (distal thenar perforator-based island flap). Plast Reconstr Surg, 2010, 125(2): 601-608.
11.	Omokawa S, Tanaka Y, Ryu J, et al. Anatomical consideration of reverse-flow island flap transfer from the midpalm for finger reconstruction. Plast Reconstr Surg, 2001, 108(7): 2020-2025.
12.	Omokawa S, Tanaka Y, Shigematsur K, et al. Reverse-flow island flap from the thenar area of the hand. J Reconstr Microsurg, 2002, 18(8): 659-664.
13.	王友華, 湯錦波, 成紅兵, 等. 帶血管神經蒂的大魚際近端皮瓣修復指腹缺損. 中華手外科雜志, 2001, 17(4): 206-208.
14.	孫戰勝. 薄型皮瓣修復手部外傷后軟組織缺損. 中國修復重建外科雜志, 1997, 11(6): 353-355.
15.	Lee TP, Liao CY, Wu IC, et al. Free flap from the superficial palmar branch of the radial artery (SPBRA flap) for finger reconstruction. J Trauma, 2009, 66 (4): 1173-1179.

1. Jihui JU, Liu Y, Hou R. Ulnar artery distal cutaneous descending branch as free flap in hand reconstruction. Injury, 2009, 40(12): 1320-1326.
2. Gao W, Yan H, Li Z, et al. The free dorsoradial forearm perforator flap: anatomical study and clinical application in finger reconstruction. Ann Plast Surg, 2011, 66(1): 53-58.
3. Chen C, Tang P, Zhang X. Sensory reconstruction of a finger pulp defect using a dorsal homodigital island flap. Plast Reconstr Surg, 2012, 130(5): 1077-1086.
4. Takeishi M, Shinoda A, Sugiyama A, et al. Innervated reverse dorsal digital island flap for fingertip reconstruction. J Hand Surg (Am), 2006, 31(7): 1094-1099.
5. 李學淵, 王曉峰, 滕曉峰, 等. 游離腓動脈肌皮穿支皮瓣修復手部皮膚缺損. 中華手外科雜志, 2007, 23(4): 214-215.
6. Sakai S. Free flap from the flexor aspect of the wrist for resurfacing defects of the hand and fingers. Plast Reconstr Surg, 2003, 111(4): 1412-1420.
7. 趙民, 田德虎, 邵新中, 等. 腕部掌側橈動脈掌淺支橫行微型皮瓣的解剖學研究. 中國修復重建外科雜志, 2013, 27(7): 864-868.
8. Yang JW, Kim JS, Lee DC, et al. The radial artery superficial palmar branch flap: a modified free thenar flap with constant innervation. J Reconstr Microsurg, 2010, 26(8): 529-538.
9. Sassu P, Lin CH, Lin YT, et al. Fourteen cases of free thenar flap: a rare indication in digital reconstruction. Ann Plast Surg, 2008, 60(3): 260-266.
10. Kim KS, Kim ES, Hwang JH, et al. Thumb reconstruction using the radial midpalmar (perforator-based) island flap (distal thenar perforator-based island flap). Plast Reconstr Surg, 2010, 125(2): 601-608.
11. Omokawa S, Tanaka Y, Ryu J, et al. Anatomical consideration of reverse-flow island flap transfer from the midpalm for finger reconstruction. Plast Reconstr Surg, 2001, 108(7): 2020-2025.
12. Omokawa S, Tanaka Y, Shigematsur K, et al. Reverse-flow island flap from the thenar area of the hand. J Reconstr Microsurg, 2002, 18(8): 659-664.
13. 王友華, 湯錦波, 成紅兵, 等. 帶血管神經蒂的大魚際近端皮瓣修復指腹缺損. 中華手外科雜志, 2001, 17(4): 206-208.
14. 孫戰勝. 薄型皮瓣修復手部外傷后軟組織缺損. 中國修復重建外科雜志, 1997, 11(6): 353-355.
15. Lee TP, Liao CY, Wu IC, et al. Free flap from the superficial palmar branch of the radial artery (SPBRA flap) for finger reconstruction. J Trauma, 2009, 66 (4): 1173-1179.

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腕部掌側橈動脈掌淺支橫行微型皮瓣游離移植修復手指皮膚缺損

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腕部掌側橈動脈掌淺支橫行微型皮瓣游離移植修復手指皮膚缺損

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