Yan Hede, Fan Cunyi, Zhang Feng, Gao Weiyang, Li Zhijie, Zhang Xiaolei
Department of Orthopedics, The Sixth Affiliated People’s Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Rd, Xuhui District, Shanghai 200233, China.
Ann Plast Surg. 2013 Jun;70(6):666-71. doi: 10.1097/SAP.0b013e3182433575.
Coverage of the dorsal aspect of the fingers is difficult, especially when the defect is large and multiple digits are involved with composite tissue loss and very few conventional flaps are suitable in dealing with such situation. The purpose of this study was to present our experience of reconstruction of the large dorsal digital defects with the arterialized venous flap (AVF) and evaluate its merits and demerits in this clinical setting with a comprehensive review of literature. From August 2008 to December 2010, 7 composite palmaris longus venous flaps and 5 AVFs were used in the reconstruction of extensive dorsal digital injuries in 8 patients, and a comprehensive review of literature regarding the reconstruction of dorsal digital defects with AVFs was carried out. All the flaps survived completely. The outcomes were very satisfactory for functional recovery, aesthetic appearance, and sensation restoration at an average follow-up of 11.8 months; the literature review also revealed the similar results. On the basis of our experience and literature review, AVFs are reliable and good candidates for resurfacing large dorsal digital defects when local flaps are not available or insufficient for coverage. Composite AVF with palmaris longus tendon is an optimal choice for 1-stage reconstruction of dorsal composite finger injuries.
手指背侧的覆盖较为困难，尤其是当缺损较大且多个手指受累伴有复合组织缺失时，很少有传统皮瓣适用于处理这种情况。本研究的目的是介绍我们使用动脉化静脉皮瓣（AVF）重建手指背侧大缺损的经验，并通过全面的文献综述评估其在这种临床情况下的优缺点。2008年8月至2010年12月，8例患者中使用了7个复合掌长肌静脉皮瓣和5个动脉化静脉皮瓣来重建广泛的手指背侧损伤，并对有关动脉化静脉皮瓣重建手指背侧缺损的文献进行了全面综述。所有皮瓣均完全存活。平均随访11.8个月时，功能恢复、美观外观和感觉恢复的结果非常令人满意；文献综述也显示了类似的结果。根据我们的经验和文献综述，当局部皮瓣不可用或不足以覆盖时，动脉化静脉皮瓣是修复手指背侧大缺损的可靠且良好的选择。带有掌长肌腱的复合动脉化静脉皮瓣是手指背侧复合损伤一期重建的最佳选择。
