游离桡动脉掌浅支皮瓣修复手指近指间关节严重屈曲挛缩畸形

张航 曾福俊 蒋国华 刁杰 刘渝川 刘亚平 唐林俊

[摘要]目的：探讨应用游离桡动脉掌浅支皮瓣修复手指近指间关节屈曲挛缩畸形临床疗效。方法：2017年2月-2019年2月，对7例手指近指间关节屈曲挛缩瘢痕患者进行松解，并将近指间关节固定于伸直位，同时采用游离桡动脉掌浅支皮瓣覆盖创面。术后3周拆去内固定开始功能锻炼。结果：术后随访6～19个月，腕部供区外观影响小，皮瓣柔软，手指近指间关节活动依据TAM标准，5例优，2例良。结论：游离桡动脉掌浅支皮瓣修复手指近指间关节屈曲挛缩畸形可获得满意的功能及外形，是一种较好的临床治疗方法。

[关键词]桡动脉掌浅支;手指畸形;屈曲挛缩;游离皮瓣;软组织缺损;缺损修复

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2020）07-0065-03

Abstract： Objective  To evaluate the surgical technique and clinical effect of applying free superficial palmar branch flap of radial artery for flexion contracture deformity of finger interphalangeal joint. Methods  From February 2017 to  February 2019， 7 cases of flexion contracture scar of finger proximal interphalangeal joint were released， and the proximal interphalangeal joint was fixed in the straight position. At the same time， superficial palmar branch flap of radial artery was used to cover the wound. Three weeks after operation， the internal fixation was removed and functional exercise was started. Results  The patients were followed up for 6 to 19 months. The superficial palmar branch flap of radial artery of 7 patients survived well after operation. Follow-up patients had little effect on the appearance of the donor area of wrist， soft flap， finger function and shape recovered well. According to TAM standard， 5 cases were excellent and 2 cases were good. Conclusion  Free superficial palmar branch flap of radial artery for the repair of flexion contracture deformity of finger interphalangeal joint can obtain satisfactory function and shape. It is a better method for the treatment of skin defect in finger joint.

Key words： superficial palmar branch of radial artery; fingers deformities; flexion contracture; free flap; soft tissue defect; defect repair

手外伤后导致手指瘢痕挛缩并不少见，通过合理的伸屈手指锻炼可以改善临床症状。但是严重者可导致掌指关节或指间关节严重屈曲畸形，手指无法伸直，关节呈半脱位或全脱位状态，严重影响手指功能和手部美观[1]。长期手指瘢痕挛缩屈曲畸形会导致手指肌腱、韧带、神经及血管缩短，应早期接受矫形治疗[2]。对于松解术后继发的皮肤缺损创面，传统采用腹部皮瓣修复、全厚皮片修复[3];但腹部皮瓣时间长需要二次断蒂，全厚皮片移植术后会有不同程度继发挛缩，且不能覆蓋肌腱、骨关节外露创面。2017年2月-2019年2月，笔者科室应用游离桡动脉掌浅支皮瓣修复手指近指间关节屈曲挛缩畸形7例，均为外伤导致的手指严重屈曲挛缩畸形患者，松解术后此法修复皮肤软组织缺损，获得满意疗效。……