改良掌背逆行岛状皮瓣的临床应用

田恒进　盛　辉　王志勇　靖树林　严　斌　张治家

[摘要]目的：探讨切取掌背皮瓣的改进方法及其临床应用效果 方法：复习相关掌背动脉解剖学研究成果，改进掌背动脉逆行岛状皮瓣的切取方法，以背侧指蹼中点和两掌骨基底部汇合点连线设计为轴线,距指蹼缘近侧约1.5cm为旋转点，在深筋膜下、伸肌腱腱膜浅层解剖皮瓣，保留掌背动脉远端皮支，临床分别应用修复12例食、中、环、小指中、近节皮肤软组织缺损。结果：12例皮瓣全部成活,1例皮瓣术后远端出现张力性水疱，皮瓣远端部分表皮坏死, 后创面经换药后愈合。术后随访3～6 个月, 皮瓣质地、外观满意,手背部外形功能良好。结论：自深筋膜下、指伸腱膜浅面解剖皮瓣，保留掌背动脉远端皮支的掌背动脉逆行岛状皮瓣手术方法操作简便, 对供区损伤小, 应用于修复手指近、中节皮肤软组织软缺损创面临床效果好。

[关键词]掌背动脉；外科皮瓣；手指；软组织缺损；修复

[中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2009）03-0295-02

Clinical application of modified retroversal island flap based on dorsal metacarpal artery

TIAN Heng-jin,SHENG Hui, WANG Zhi-yong,JING Shu-lin,YAN Bin,ZHANG Zhi-jia

（Department of Plastic and Hands Surgery,the People's Hospital of Taixing,Taixing 225400,Jiansu,China）

Abstract: Objective To approach the operative methods and clical effect for modified retroversal island flap based on dorsal metacarpal artery. Methods Reviewing the achieved anatomy of anatomy dorsal metacarpal arteries,the modified retroversal island flap based on dorsal metacarpal artery were been dissected under the deep fascia,but on the aponeurosis of extensor tendon in order to remaining the distal end cutaneous branches of dorsal metacarpal arteries,which was been applied to recovery 12 case of soft tissue defect of fingers was been dissected under the deep fascia,but on the aponeurosis of extensor tendon in order to remaining the distal end cutaneous branches of dorsal metacarpal arteries. Results All the flaps survived with the wound healed except one flap necrosis of terminal edge of flap but healed after treatment.The postoperative following - up examinations was carried out from 3 to 6months.The results were satisfied in all 12 flaps. Conclusions It is a practical method to recover the skin defect of proximal and middle phalanx of finger effectively by using the modified retroversal island flap based on dorsal.

Key words: dorsal metacarpal arteries; surgery flap; fingers; soft tissue defect;recovery

选择一种供区破坏小而受区修复满意的皮瓣修手指皮肤软组织缺损伴骨外露、肌腱,是整形外科外科的的难题，而掌背动脉皮瓣是目前常用的皮瓣之一。自2007年7 月以来, 笔者复习掌背动脉的解剖学资料，改进掌背皮瓣的切取方法，以背侧指蹼中点和两掌骨基底部汇合点连线设计为轴线，距指蹼缘近侧约1.5cm为旋转点，在深筋膜下、伸肌腱腱膜浅层解剖皮瓣，保留掌背动脉远端皮支临床应用修复食、中、环、小指中近节皮肤缺损，以避免传统的掌背皮瓣在解剖掌背动脉时对伸肌腱的损伤。……