Wang Bin, Li Chun-Jiang, Chen Chao, Zhang Jian-Feng, Zhang Wen-Long, Ma Tie-Peng, Li Gang, Jiang Wen-Ping
Department of Hand Surgery, Second Hospital of Tangshan, Tangshan 063000, China.
Zhonghua Zheng Xing Wai Ke Za Zhi. 2011 Mar;27(2):98-101.
To explore a new method for repair of concurrent skin and nerve defect at palm and carpal on ulnar side.
From April 2000 to August 2009, five cases with concurrent skin and nerve defect at palm and carpal on ulnar side were reconstructed with free medial plantar flaps. Palmar nervous proprii defect at ulnar side of little finger was repaired by the first toe tibia nervous proprii in one case. The superficial branch of radial nerve was applied to repair the defect of ulnar nerve, as well as its deep or superficial branch in two cases. The superficial branch of radial nerve was also used to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, Little finger ulnar palmar nervous proprii in one case. The dorsal branch of ulnar nerve was applied to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, little finger ulnar palmar nervous proprii in one case. The vascular bundle of medial plantar flap was anastomosed with ulnar vascular bundle. The wounds at donor sites were covered with free skin grafts which were obtained from upper leg.
All the flaps and skin grafts were survived completely. The five patients were followed up for six months to four years with no muscular atrophy or claw hand deformity. The esthetic result was satisfied. The Sensory of flaps and fingers recovered to S3 to S3+. The two-point discrimination distance on flaps was range from 7 mm to 10 mm. The postoperative comprehensive evaluation was excellent in the cases whose superficial and deep branches of ulnar nerve were repaired.
Free medial plantar flap is an effective method to repair concurrent skin and nerve defect at palm and carpal on the ulnar side.
探索一种修复手掌尺侧及腕部皮肤与神经同时缺损的新方法。
2000年4月至2009年8月，采用游离内侧足底皮瓣修复5例手掌尺侧及腕部皮肤与神经同时缺损的患者。其中1例采用第一趾胫侧趾固有神经修复小指尺侧掌侧固有神经缺损。2例采用桡神经浅支修复尺神经缺损及其深支或浅支。1例采用桡神经浅支修复尺神经浅支、环指掌侧总神经、小指尺侧掌侧固有神经缺损。1例采用尺神经手背支修复尺神经浅支、环指掌侧总神经、小指尺侧掌侧固有神经缺损。将内侧足底皮瓣的血管束与尺侧血管束吻合。供区创面采用取自大腿的游离皮片覆盖。
所有皮瓣及皮片均完全成活。5例患者随访6个月至4年，无肌肉萎缩或爪形手畸形，外形满意。皮瓣及手指感觉恢复至S3～S3+。皮瓣两点辨别觉距离为7～10mm。尺神经浅支和深支修复的病例术后综合评价优良。
游离内侧足底皮瓣是修复手掌尺侧及腕部皮肤与神经同时缺损的有效方法。
