带掌长肌腱的动脉化Flow-through静脉皮瓣修复指背侧复合组织缺损

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目的:探讨带掌长肌腱的动脉化Flow-through静脉皮瓣修复指背侧复合组织缺损的疗效。方法:自2010年3月至2018年12月,应用带掌长肌腱的动脉化Flow-through静脉皮瓣修复指背侧复合组织缺损23例23指,男17例17指,女6例6指,年龄23~53(平均37.2)岁。致伤原因:绞伤15例,电刨伤5例,热压伤3例。均为指背侧复合组织缺损,其中拇指1例,示指11例,中指9例,环指2例。均为软组织及肌腱缺损,软组织缺损面积2.0 cm×1.8 cm~4.2 cm×2.6 cm,肌腱缺损长度1.6~2.6 cm;其中1例伴有伸肌腱终腱止点及中央腱止点缺损,5例伴有终腱止点缺损。3例为急诊手术修复,20例为亚急诊手术修复。供区直接缝合。术后门诊随访皮瓣的外形、色泽、质地、感觉、指体功能恢复情况和供区外形。结果:术后随访8~23个月,平均11个月。皮瓣外形无臃肿,质地柔软,有轻度色素沉着,保护性感觉恢复;指近侧及远侧指骨间关节总活动度145°~170°,平均162.6°,按Strickland手功能评定方法评定,结果全为优。结论:带掌长肌腱的动脉化Flow-through静脉皮瓣是修复指背侧复合组织缺损的一种较理想修复方法。“,”Objective:To investigate the effect of arterialised Flow-through venous flap with palmaris longus tendon in repairing dorsal digit composite tissue defect.Methods:From March, 2010 to December, 2018, 23 cases (23 digits) of dorsal digit composite tissue defect were repaired with arterialised Flow-through venous flap with palmaris longus tendon. There were 17 males and 6 females aged between 23 to 53 (average, 37.2) years old. Causes of injury: 15 cases of strangulation, 5 of electric plane and 3 of thermal crush. Number of injured digit were 1 thumb, 11 index fingers, 9 middle fingers and 2 ring fingers. All of the injured digits had skin and extensor tendon defects with an area of 2.0 cm×1.8 cm-4.2 cm×2.6 cm, and the length of extensor tendon defect was 1.6-2.6 cm. One case had terminal and central tendon insertion defects and 5 suffered with terminal tendon insertion defect. Three cases were repaired by emergency surgery, and 20 were repaired by sub-emergency surgery. All donor sites were directly sutured. The shape, colour, texture, sensation, recovery of digit function and donor site appearance were followed-up at outpatient clinic.Results:The patients were followed-up for 8 to 23 (average, 11) months. The flap was soft, with mild pigmentation and recovery of protective sensation. The range of motion of the proximal and distal interphalangeal joints was 145°-170° (average,162.6°). According to Strickland hand function evaluation method, the results were excellent.Conclusion:The arterialised Flow-through venous flap with palmaris longus tendon is an ideal method in repair of the dorsal digit composite tissue defect.
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