| 林宏伟,吴杰,江标,等.游离同侧前臂穿支皮瓣修复指端缺损.骨科,2015,6(4): 190-195. |
| 游离同侧前臂穿支皮瓣修复指端缺损 |
| Transfer of free ipsilateral forearm perforator flap for fingertip defect reconstruction |
| 投稿时间：2015-03-19 |
| DOI：10.3969/j.issn.1674-8573.2015.04.006 |
| 中文关键词: 指端缺损 穿支皮瓣 修复 治疗 |
| 英文关键词: Fingertip defect Perforator flap Repair Treatment |
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| 中文摘要: |
| 目的 分析探讨游离同侧前臂穿支皮瓣修复指端缺损的临床经验。方法 自2011年6月至2014年6月，本科采用游离同侧前臂穿支皮瓣修复17例（18指）患者指端缺损，采用中华医学会手外科学会上肢部分功能评分试用标准等评定疗效。结果 其中14个皮瓣顺利成活。2个骨间背侧穿支皮瓣、1个尺动脉穿支皮瓣、1个桡动脉穿支皮瓣在术后24 h内出现静脉危象。视循环危象具体情况分别采用拆除皮瓣部分缝线，皮瓣小切口放血，皮瓣按摩等方法处理，未行手术血管探查。2个皮瓣存活、1个部分坏死、1个全部坏死，全部坏死病例改用邻指皮瓣修复。患者均获得3.0～12.0个月随访，平均随访5.8个月。皮瓣色泽红润、质地柔软、外观自然、不臃肿，与周围皮肤接近。指端饱满，外形良好。两点辨别觉8～12 mm，无严重触痛。患指各关节活动基本正常，无关节坚硬。患者对指端感觉及伤指外形均较为满意，能适应正常的工作与生活。按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12指，良4指，可2指，优良率88.9%。结论 游离同侧前臂穿支皮瓣移植修复指端缺损，皮瓣供区、受区位于同一上肢、同一术野。患者仅需在一侧臂丛神经阻滞麻醉下即可接受手术，可在止血带控制下进行无血、无创操作。手术操作简单、麻醉方便，成功率高。手术不破坏手背及手指组织，不损伤主干血管，损伤小。但是，手术需要较高显微外科技术，有一定的皮瓣坏死率，手术风险较高。 |
| 英文摘要: |
| Objective To investigate the clinical outcomes of treating fingertip defects with free transplantation of ipsilateral forearm perforator flap. Methods From Jun. 2011 to Jun. 2014, 18 fingers from 17 cases of fingertip defects were treated with free transplantation of ipsilateral forearm perforator flap, the upper limb functional assessment criteria issued by the Chinese Medical Association Hand Surgery Society was used to evaluate the clinical effect. We recorded and generalized the clinical materials. Results Fourteen flaps survived uneventfully. Venous crisis occurred in 2 posterior interosseous artery perforator flaps, 1 ulnar artery perforator flap and 1 radial artery perforator flap within 24 h of the surgery. Based on the reasons which caused the cyclic crisis, such as removing some stitches, small incision bleeding, flap massage and so on were used. We did not take vascular probes. Two flaps survived, 1 had partial necrosis and 1 had total necrosis. Neighbour flap was used to repair the total necrosis. All cases were followed-up from 3.0 to 12.0 months (average 5.8 months). The color, texture and contour of the flaps were good. There were no bulkiness, and no ankylosis. Tow-point discrimination was 8 to 12 mm. Joint movement of the fingers was normal. The patients could adapt to normal work and life. They were satisfied with the exterior and the sensation of the fingertip post-operatively. Based on the upper limb functional assessment criteria issued by the Chinese Medical Association Hand Surgery Society, the results were rated as excellent in 12 fingers, good in 4 fingers and fair in 2 fingers. The overall satisfactory rate was 88.9%. Conclusion Treating fingertip defect with free transplantation of ipsilateral forearm perforator flap, the donor and the recipient locate in the same upper limb, and there is the same surgical field. The patients only need one brachial plexus anesthesia. Furthermore, it may be a noninvasive recipient locate in the same upper limb, and there is the same surgical field. The patients only need one brachial plexus anesthesia. Furthermore, it may be a noninvasive surgery done in a bloodless under the control of the tourniquet. The surgical operation and the anesthesia are simple. It has high success rate. It does little harm to the hand, the finger and the main vessels. That is to say, it has little side effect. However, it needs complex microsurgical technique and has considerable necrosis rate, and the surgical risk is still high. |
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